Staged versus index procedure complete revascularization in ST‐elevation myocardial infarction: A meta‐analysis |
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| Authors: | Nayan Agarwal MD Ankur Jain MD Jalaj Garg MD Mohammad Khalid Mojadidi MD Ahmed N Mahmoud MD Nimesh Kirit Patel MD Sahil Agrawal MD Tanush Gupta MD Nirmanmoh Bhatia MD R David Anderson MD |
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| Institution: | 1. Department of Medicine, University of Florida, Gainesville, Florida;2. Department of Medicine, Lehigh Valley Health Network, Allentown, Pennsylvania;3. Department of Medicine, Virginia Commonwealth University Health System, Richmond, Virginia;4. Department of Medicine, St. Lukes University Health Network, Bethlehem, Pennsylvania;5. Department of Medicine, Montefiore Medical Centre, Albert Einstein College of Medicine, Bronx, New York;6. Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee |
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| Abstract: | Background Complete revascularization of patients with ST‐elevation myocardial infarction and multivessel coronary artery disease reduces adverse events compared to infarct‐related artery only revascularization. Whether complete revascularization should be done as multivessel intervention during index procedure or as a staged procedure remains controversial. Method We performed a meta‐analysis of randomized controlled trials comparing outcomes of multivessel intervention in patients with ST‐elevation myocardial infarction and multivessel coronary artery disease as staged procedure versus at the time of index procedure. Composite of death or myocardial infarction was the primary outcome. Mantel‐Haenszel risk ratios were calculated using random effect model. Results Six randomized studies with a total of 1126 patients met our selection criteria. At a mean follow‐up of 13 months, composite of myocardial infarction or death (7.2% vs 11.7%, RR: 1.66, 95%CI: 1.09‐2.52, P = 0.02), all cause mortality (RR: 2.55, 95%CI: 1.42‐4.58, P < 0.01), cardiovascular mortality (RR: 2.8, 95%CI: 1.33‐5.86, P = 0.01), and short‐term (<30 days) mortality (RR: 3.54, 95%CI: 1.51‐8.29, P < 0.01) occurred less often in staged versus index procedure multivessel revascularization. There was no difference in major adverse cardiac events (RR: 1.14, 95%CI: 0.88‐1.49, P = 0.33), repeat myocardial infarction (RR: 1.14, 95%CI: 0.68‐1.92, P = 0.61), and repeat revascularization (RR: 0.92, 95%CI: 0.66‐1.28, P = 0.62). Conclusion In patients with ST‐elevation myocardial infarction and multivessel coronary artery disease, a strategy of complete revascularization as a staged procedure compared to index procedure revascularization results in reduced mortality without an increase in repeat myocardial infarction or need for repeat revascularization. |
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| Keywords: | index revascularization multivessel PCI staged revascularization STEMI |
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