Meta-Analysis Comparing Complete Versus Infarct-Related Artery Revascularization in Patients With ST-Elevation Myocardial Infarction and Multivessel Coronary Disease

• Published in: The American journal of cardiology 2020-02, Vol.125 (4), p.513-520
• Main Authors: Osman, Mohammed, Khan, Safi U., Farjo, Peter D., Chima, Noor, Kheiri, Babikir, Zahr, Firas, Alkhouli, Mohamad
• Format: Article
• Language: English
• Subjects: Angioplasty; Bias; Cardiovascular disease; Cardiovascular diseases; Cerebral infarction; Clinical outcomes; Clinical trials; Collaboration; Confidence intervals; Coronary Artery Disease - surgery; Heart attacks; Heart diseases; Humans; Meta-analysis; Mortality; Myocardial infarction; Myocardial Revascularization - methods; Nephropathy; Reduction; Risk management; Sensitivity analysis; ST Elevation Myocardial Infarction - surgery; Stroke
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/j.amjcard.2019.11.017

A strategy of complete revascularization (CR) versus infarct-related artery revascularization (IRA) in patients with ST-elevation myocardial infarction (STEMI) continues to be a subject of debate. We performed an updated meta-analysis to compare the 2 strategies. Outcomes of interest included major adverse cardiovascular events (MACE), cardiovascular mortality, all-cause mortality, stroke, repeat revascularization, myocardial infarction, and contrast-induced nephropathy. Ten randomized trials including 7,423 patients (CR = 3,574 and IRA = 3,849), with a follow-up of 2.0 ± 0.8 years were included. There was a significant reduction in MACE with CR versus IRA (10.7% vs 18.6%, relative risk [RR] 0.64, 95% confidence interval [CI] 0.51 to 0.81, p = 0.002, I2 = 66%), with higher risk reduction with immediate versus stages revascularization (RR 0.40, 95% CI 0.32 to 0.5 vs RR 0.69, 95% CI 0.54 to 0.89, P-interaction = 0.002). Complete revascularization was associated with lower rates of repeat revascularization (4.0% vs 11.7%, RR 0.44, 95% CI 0.28 to 0.70, p