A Meta-analysis Of Complete Or Partial Revascularization In NSTE-ACS Patients With Multiple Vessel Disease

Backround: Most patients with non-ST-segment elevation acute coronary syndrome often have multiple coronary artery lesions.In these patients,the strategy of revascularization in coronary intervention therapy has not yet been clearly defined.The merits and demerits of two strategies that complete revascularization in multi-vessel lesions or partial revascularization in criminals are needed to further study.Methods: PubMed,CBM,EMBASE,Cochrane Library,Wanfang and Weipu databases were searched comprehensively for relevant literatures.The retrieval period was from the establishment of the database to December 312018.Two people independently evaluated the literature and extracted the data.Newcastle-Ottawa Scale(NOS)was used to evaluate the quality of the literature.Stata12.0 was used to complete the statistical analysis of the data.Results: Nine articles were included,totaling 30183 patients,of whom14942 were treated with multi-vessel coronary intervention,and only 15241 patients were treated with criminal coronary intervention.Meta-analysis showed that:Relative risk ratios(RR)of all-cause mortality,revascularization,recurrent myocardial infarction and major adverse cardiac events(MACE)werecalculated using a random effect model.The results showed that there was no significant difference in major adverse cardiac events(MACE)rates(RR 0.87;95% CI 0.74-1.02;I2 73.7%;P = 0.000),all-cause mortality(RR 0.71;95% CI0.35-1.44;I2 95.3%)and recurrent myocardial infarction rates(RR 0.89;95%CI 0.63-1.26;I2 51.5%;P = 0.036)between the multi-vessel coronary intervention group and the single vessel coronary intervention group.Although the risk of revascularization(RR 0.77;95% CI 0.60-0.99;I2 76.1%;P = 0.000)suggested that the risk of revascularization could be significantly reduced in the multi-vessel coronary intervention group,the subgroup analysis showed no significant difference between the two groups.Compared with single-vessel coronary intervention group,multi-vessel coronary intervention group could significantly reduce the risk of cardiogenic death(RR 0.62;95% CI 0.42-0.90;I2 0.0%;P = 0.500).Conclusion: Compared with partial revascularization,complete revascularization can significantly reduce the incidence of cardiogenic death in NSTE-ACS patients with multi-vessel lesions,but it does not reduce the incidence of major adverse cardiac events,all-cause deaths,recurrent myocardial infarction and revascularization.More randomized controlled trials are needed to compare the safety and effectiveness of the two strategies in this case.