Meta-Analysis of Multivessel Coronary Artery Revascularization Versus Culprit-Only Revascularization in Patients With ST-Segment Elevation Myocardial Infarction and Multivessel Disease
- Authors
- Bangalore, Sripal; Kumar, Sunil; Poddar, Kanhaiya L.; Ramasamy, Sureshkumar; Rha, Seung-Woon; Faxon, David P.
- Issue Date
- 1-5월-2011
- Publisher
- EXCERPTA MEDICA INC-ELSEVIER SCIENCE INC
- Citation
- AMERICAN JOURNAL OF CARDIOLOGY, v.107, no.9, pp.1300 - 1310
- Indexed
- SCIE
SCOPUS
- Journal Title
- AMERICAN JOURNAL OF CARDIOLOGY
- Volume
- 107
- Number
- 9
- Start Page
- 1300
- End Page
- 1310
- URI
- https://scholar.korea.ac.kr/handle/2021.sw.korea/112480
- DOI
- 10.1016/j.amjcard.2010.12.039
- ISSN
- 0002-9149
- Abstract
- American College of Cardiology/American Heart Association guidelines for management of patients with ST-segment elevation myocardial infarction (STEW) recommend culprit artery-only revascularization (CULPRIT) based on safety concerns during noninfarct-related artery intervention. However, the data to support this safety concern are scant. Searches were performed in PubMed/EMBASE/CENTRAL for studies evaluating multivessel revascularization versus CULPRIT in patients with STEMI and multivessel disease (MVD). A multivessel revascularization strategy had to be performed at the time of CULPRIT or during the same hospitalization. Early (<= 30-day) and long-term outcomes were evaluated. Among 19 studies (23 arms) that evaluated 61,764 subjects with STEMI and MVD, multivessel revascularization was performed in a minority of patients (16%). For early outcomes, there was no significant difference for outcomes of mortality, MI, stroke, and target vessel revascularization, with a 44% decrease in risk of repeat percutaneous coronary intervention and major adverse cardiovascular events (odds ratio 0.68, 95% confidence interval 0.57 to 0.81) with multivessel revascularization compared to CULPRIT. Similarly, for long-term outcomes (follow-up 2.0 +/- 1.1 years), there was no difference for outcomes of MI, target vessel revascularization, and stent thrombosis, with 33%, 43%, and 53% decreases in risk of mortality, repeat percutaneous coronary intervention, coronary artery bypass grafting, respectively, and major adverse cardiovascular events (odds ratio 0.60, 95% confidence interval 0.50 to 0.72) with multivessel revascularization compared to CULPRIT. In conclusion, in patients with STEMI and MVD, multivessel revascularization appears to be safe compared to culprit artery-only revascularization. These findings support the need for a large-scale randomized trial to evaluate revascularization strategies in patients with STEMI and MVD. (C) 2011 Elsevier Inc. All rights reserved. (Am J Cardiol 2011;107:1300-1310)
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