PT  - JOURNAL ARTICLE
AU  - Kowalewski, Mariusz
AU  - Schulze, Volker
AU  - Berti, Sergio
AU  - Waksman, Ron
AU  - Kubica, Jacek
AU  - Kołodziejczak, Michalina
AU  - Buffon, Antonino
AU  - Suryapranata, Harry
AU  - Gurbel, Paul Alfred
AU  - Kelm, Malte
AU  - Pawliszak, Wojciech
AU  - Anisimowicz, Lech
AU  - Navarese, Eliano Pio
TI  - Complete revascularisation in ST-elevation myocardial infarction and multivessel disease: meta-analysis of randomised controlled trials
AID  - 10.1136/heartjnl-2014-307293
DP  - 2015 Aug 15
TA  - Heart
PG  - 1309--1317
VI  - 101
IP  - 16
4099  - http://heart.bmj.com/content/101/16/1309.short
4100  - http://heart.bmj.com/content/101/16/1309.full
SO  - Heart2015 Aug 15; 101
AB  - Background Current guidelines recommend culprit-only revascularisation (COR) in haemodynamically stable patients with ST-segment elevation myocardial infarction (STEMI) and multivessel (MV) disease. Contrarily, growing body of evidence available from recent randomised controlled trials (RCTs) demonstrates improved outcomes with complete MV-percutaneous coronary intervention (PCI).Methods and results We performed a meta-analysis of RCTs comparing complete MV-PCI with non-complete MV-PCI in STEMI and MV disease. Complete MV-PCI was defined as revascularisation to non-infarct-related artery lesions during index procedure, non-complete MV-PCI-encompassed COR and staged approaches. Multiple databases and congress proceedings from major cardiovascular societies’ meetings were screened for relevant studies. Primary endpoint was the composite of major adverse cardiac events (MACE) typically defined as death, recurrent myocardial infarction (MI) and repeat revascularisation. Secondary endpoints were cardiovascular mortality, recurrent MI and repeat revascularisation. Outcomes were analysed at longest available follow-up with differences accounted for with adjusted models by person-years. Seven RCTs (N=1303) were included. The median follow-up was 12 months. Complete MV-PCI reduced the odds of MACE compared with non-complete MV-PCI (OR (95% CIs) 0.59 (0.36 to 0.97), p=0.04) driven by reduction in recurrent MI (0.48 (0.27 to 0.85), p=0.01) and repeat revascularisation (0.51 (0.31 to 0.84), p=0.008). Complete MV-PCI was associated with a non-significant trend towards reduced cardiovascular mortality (0.54 (0.26 to 1.10), p=0.09) as well. In a sensitivity analysis, none of the baseline clinical variables significantly influenced overall estimates.Conclusions In STEMI and MV disease, complete MV-PCI as compared with non-complete strategy reduces MACE by 41%, driven by a 52% reduction in recurrent MI and 49% reduction in repeat revascularisation.