Early Complete Revascularization in Hemodynamically Stable Patients With ST-Segment Elevation Myocardial Infarction and Multivessel Disease

Federico Fortuni, Gabriele Crimi, Filippo Angelini, Sergio Leonardi, Fabrizio D'Ascenzo, Marco Ferlini, Marco Rolando, Arturo Raisaro, Luigi Oltrona Visconti, Maurizio Ferrario, Massimiliano Gnecchi, Gaetano M. De Ferrari

Research output: Contribution to journalReview articlepeer-review

Abstract

Background: The optimal strategy and timing of revascularization in hemodynamically stable patients with ST-segment elevation myocardial infarction and multivessel disease is unknown. We performed a systematic review and meta-analysis to explore the comparative efficacy and safety of early complete revascularization vs culprit-only or staged revascularization in this setting. Methods: We searched the literature for randomized clinical trials that assessed this issue. Early complete revascularization was defined as a complete revascularization achieved during the index procedure or within 72 hours. Efficacy outcomes were major adverse cardiovascular events, myocardial infarction, repeat revascularization, and all-cause mortality. Safety outcomes were all bleeding events, stroke, and contrast-induced acute kidney injury. Results: Nine randomized clinical trials with a total of 2837 patients were included; 1254 received early complete revascularization and 1583 were treated with other revascularization strategies. After a mean follow-up of 15.3 ± 9.4 months early complete revascularization was associated with a lower risk of major adverse cardiovascular events (relative risk [RR], 0.51; 95% confidence interval [CI], 0.41-0.62; P < 0.00001; number needed to treat = 8), myocardial infarction (RR, 0.59; 95% CI, 0.40-0.87), and repeat revascularization (RR, 0.39; 95% CI, 0.28-0.55) without any difference in all-cause mortality and in safety outcomes compared with culprit-only or staged revascularization. Moreover, fractional flow reserve-guided complete revascularization reduced the incidence of repeat revascularization compared with angiography-guided procedure (χ2 = 4.36; P = 0.04). Conclusions: Early complete revascularization should be considered in hemodynamically stable patients with ST-segment elevation myocardial infarction and multivessel disease deemed suitable for percutaneous interventions. Fractional flow reserve-guided complete revascularization might be superior to angiography-guided procedures in reducing need for further interventions.

Original languageEnglish
Pages (from-to)1047-1057
Number of pages11
JournalCanadian Journal of Cardiology
Volume35
Issue number8
DOIs
Publication statusPublished - Aug 1 2019

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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