Complete Versus Culprit Vessel Only Revascularization In Patients With Acute St-segment Elevation Myocardial Infarction And Multivessel Disease During Primary Percutaneous Coronary Intervention: A Meta-analysis

Background:Current guidelines on the management of acute ST-segment elevation myocardial infarction(STEMI) patients with multivessel disease(MVD) during primary percutaneous coronary intervention(PCI) recommend revascularization should be limited to the culprit vessel. In light of some new favorable data from recently completed randomized clinical trials(RCTs), it is necessary to assess whether complete revascularization(CR) is superior to culprit vessel only revascularization(COR). Methods:We conducted a comprehensive search of Pub Med, EMBASE and the Cochrane Library databases to obtain RCTs published up to October 2014(updated in March 2015). Data extraction, study selection and methodological quality were done or evaluated independently by two investigators. The methodological quality of the RCTs was assessed using the 5-point scale developed by Jadad et al. Pooled data were estimated using random effect model. All data analysis was conducted using Rev Man analyses software(Rev Man 5.2). Results:Overall, six RCTs with 1149 patients were included. Compared with COR, CR was associated with a reduction in the rate of overall major adverse cardiac events(MACE)(RR, 1.63; 95% CI, 1.14–2.33; I2=31%), repeat revascularization(RR, 1.93; 95% CI, 1.24–3.00; I2=45%) and recurrent myocardial infarction(MI)(RR, 2.36; 95% CI, 1.32–4.24; I2=0%), but with no significant difference in terms of all cause mortality(RR, 1.50; 95% CI, 0.90–2.52; I2=0%) and renal dysfunction(RR, 2.65; 95% CI, 0.54–13.01; I2=0%). However, no difference on all outcomes was observed within 12 months according to the subgroup analysis, once the follow over 12 months, significant difference was existed. Sensitivity analysis indicated that most results of the present meta-analysis are steady. Conclusion:CR was effective in reducing the risk of overall MACE, repeat revascularization and recurrent MI. There were no significant risks or benefits for all cause mortality or renal dysfunction. Additional large-scale, randomized, controlled trials are necessary to assess these outcomes.