Multi-vessel versus culprit-vessel and staged percutaneous coronary intervention in STEMI patients with multivessel disease: a meta-analysis of randomized controlled trials.

Autor: Dahal K; Department of Medicine, LRGHealthcare, Laconia, NH. Electronic address: kdahal@lrgh.org., Rijal J; Department of Medicine, Miriam Hospital, Brown University, Providence, RI., Panta R; Department of Medicine, LRGHealthcare, Laconia, NH., Lee J; Calhoun Cardiology Center, University of Connecticut Health Center, Farmington, CT., Azrin M; Calhoun Cardiology Center, University of Connecticut Health Center, Farmington, CT., Lootens R; Department of Medicine, LRGHealthcare, Laconia, NH; Concord Cardiac Associates, Dartmouth Hitchcock Medical Center, Concord, NH.
Jazyk: angličtina
Zdroj: Cardiovascular revascularization medicine : including molecular interventions [Cardiovasc Revasc Med] 2014 Nov-Dec; Vol. 15 (8), pp. 408-13. Date of Electronic Publication: 2014 Oct 16.
DOI: 10.1016/j.carrev.2014.10.007
Abstrakt: Introduction: Percutaneous coronary intervention (PCI) is preferred in patients with acute ST-elevation myocardial infarction (STEMI). In patients with acute STEMI with multivessel disease (MVD), the guidelines recommend culprit vessel PCI (CV-PCI) in the absence of hemodynamic instability. We performed a meta-analysis of all randomized controlled trials (RCTs) comparing multi-vessel PCI (MV-PCI) with CV-PCI or staged PCI (S-PCI) in patients with acute STEMI and MVD.
Methods: PubMed, EMBASE and CENTRAL were searched for publications since inception to December 2013. Random effects model was used to compute summary effects.
Results: Four RCTs (840 patients) were identified. MV-PCI compared to CV-PCI significantly reduced the risks of major adverse cardiac events (MACE)-a composite of MI, revascularization and all-cause mortality (RR: 0.46, 95% CI: 0.35-0.60, P<0.00001) by reducing the risks of MI (0.35, 0.17-0.71, P=0.004) and revascularization (0.35, 0.24-0.52, P<0.00001). The risk of all-cause mortality was not different (0.69, 0.39-1.21, P=0.19). S-PCI and MV-PCI had similar risks of MACE (0.96, 0.59-1.57, P=0.87), MI (0.60, 0.20-1.78, P=0.36), revascularization (0.86, 0.47-1.54, P=0.60) and all-cause mortality (1.50, 0.44-5.07, P=0.57).
Conclusions: MV-PCI compared to CV-PCI resulted in lower risks of MACE driven by lower MI and revascularization in patients with STEMI and multi-vessel disease.
(Copyright © 2014 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
Externí odkaz: