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Clinical impact of simultaneous complete revascularization vs. culprit only primary angioplasty in patients with st-elevation myocardial infarction and multivessel disease: a meta-analysis

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Abstract

Primary Percutaneous Intervention (PCI) is the treatment of choice for acute ST-elevation myocardial infarction (STEMI). Nearly half of STEMI patients have multivessel (MV) disease that has been associated with worse survival. However, current guidelines recommend to treat only the culprit artery (COR) during the acute procedure. Thus, the aim of the current study was to perform a meta-analysis of trials comparing MV PCI vs. COR for STEMI patients with MV disease. Medline/CENTRAL and Web were searched for comparative studies (both randomized and non randomized trials) about MV PCI vs. COR for STEMI patients reporting mortality, re-PCI and re-MI data. Primary endpoint was 30-day mortality. The meta-analysis included 10 studies (2 randomized and 8 registries; N = 31224). As compared with COR, MV PCI significantly reduced long term rate of re-PCI (OR [95% CI] = 0.47 [0.28–0.78], P = 0.003) without increasing 30-day mortality (OR [95% CI] = 1.30 [0.79–2.12], P = 0.31) and long term re-MI (OR [95% CI] = 0.94 [0.43–2.06], P = 0.88). This meta-analysis showed safety and efficacy of MV PCI approach as compared with COR, with a significant reduction in rate of revascularizations, but no advantages in death and re-MI.

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References

  1. Muller DW, Topol EJ, Ellis SG, Sigmon KN, Lee K, Califf RM (1991) Multivessel coronary artery disease: a key predictor of short-term prognosis after reperfusion therapy for acute myocardial infarction. Thrombolysis and Angioplasty in Myocardial Infarction (TAMI) Study Group. Am Heart J 121:1042–1049

    Article  CAS  PubMed  Google Scholar 

  2. Jaski BE, Cohen JD, Trausch J, Marsh DG, Bail GR, Overlie PA, Skowronski EW, Smith SC Jr (1992) Outcome of urgent percutaneous transluminal coronary angioplasty in acute myocardial infarction: comparison of single-vessel versus multivessel coronary artery disease. Am Heart J 124:1427–1433

    Article  CAS  PubMed  Google Scholar 

  3. Van de Werf F, Bax J, Betriu A, Blomstrom-Lundqvist C, Crea F, Falk V, Filippatos G, Fox K, Huber K, Kastrati A, Rosengren A, Steg PG, Tubaro M, Verheugt F, Weidinger F, Weis M; ESC Committee for Practice Guidelines (CPG), Vahanian A, Camm J, De Caterina R, Dean V, Dickstein K, Filippatos G, Funck-Brentano C, Hellemans I, Kristensen SD, McGregor K, Sechtem U, Silber S, Tendera M, Widimsky P, Zamorano JL, Silber S, Aguirre FV, Al-Attar N, Alegria E, Andreotti F, Benzer W, Breithardt O, Danchin N, Di Mario C, Dudek D, Gulba D, Halvorsen S, Kaufmann P, Kornowski R, Lip GY (2008) Management of acute myocardial infarction in patients presenting with persistent ST-segment elevation: the task force on the management of ST-segment elevation acute myocardial infarction of the European Society of Cardiology. Eur Heart J 29:2909–2945

    Google Scholar 

  4. Antman EM, Hand M, Armstrong PW, Bates ER, Green LA, Halasyamani LK, Hochman JS, Krumholz HM, Lamas GA, Mullany CJ, Pearle DL, Sloan MA, Smith SC Jr, Anbe DT, Kushner FG, Ornato JP, Pearle DL, Sloan MA, Jacobs AK, Adams CD, Anderson JL, Buller CE, Creager MA, Ettinger SM, Halperin JL, Hunt SA, Lytle BW, Nishimura R, Page RL, Riegel B, Tarkington LG, Yancy CW (2008) 2007 focused update of the ACC/AHA 2004 guidelines for the management of patients with ST-elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 51:210–247

    Article  PubMed  Google Scholar 

  5. De Luca G, Suryapranata H, Stone GW, Antoniucci D, Tcheng JE, Neumann FJ, Van de Werf F, Antman EM, Topol Ej (2005) Abciximab as adjunctive therapy to reperfusion in acute ST-segment elevation myocardial infarction: a meta-analysis of randomized trials. JAMA 293:1759–1765

    Article  PubMed  Google Scholar 

  6. De Luca G, Suryapranata H, Stone GW, Antoniucci D, Biondi-Zoccai G, Kastrati A, Chiariello M, Marino P (2008) Coronary stenting versus balloon angioplasty for acute myocardial infarction: a meta-regression analysis of randomized trials. Int J Cardiol 126:37–44

    Article  PubMed  Google Scholar 

  7. De Luca G, Gibson CM, Bellandi F, Murphy S, Maioli M, Noc M, Zeymer U, Dudek D, Arntz HR, Zorman S, Gabriel HM, Emre A, Cutlip D, Biondi-Zoccai G, Rakowski T, Gyongyosi M, Marino P, Huber K, van’t Hof AW (2008) Early glycoprotein IIb-IIIa inhibitors in primary angioplasty (EGYPT) cooperation: an individual patient data meta-analysis. Heart 94:1548–1558

    Article  PubMed  Google Scholar 

  8. De Luca G, Dudek D, Sardella G, Marino P, Chevalier B, Zijlstra F (2008) Adjunctive manual thrombectomy improves myocardial perfusion and mortality in patients undergoing primary percutaneous coronary intervention for ST-elevation myocardial infarction: a meta-analysis of randomized trials. Eur Heart J 29:3002–3010

    Article  PubMed  Google Scholar 

  9. De Luca G, Valgimigli M, Spaulding C, Menichelli M, Brunner-La Rocca HP, van der Hoeven BL, Di Lorenzo E, Diaz de la Llera LS, Pasceri V, Pittl U, Percoco G, Violini R, Stone GW (2009) Adjunctive manual thrombectomy improves myocardial perfusion and mortality in patients undergoing primary percutaneous coronary intervention for ST-elevation myocardial infarction: a meta-analysis of randomized trials. J Thromb Thrombolysis 28:200–210

    Article  CAS  PubMed  Google Scholar 

  10. De Luca G, Stone GW, Suryapranata H, Laarman GJ, Menichelli M, Kaiser C, Valgimigli M, Di Lorenzo E, Dirksen MT, Spaulding C, Pittl U, Violini R, Percoco G, Marino P (2009) Adjunctive manual thrombectomy improves myocardial perfusion and mortality in patients undergoing primary percutaneous coronary intervention for ST-elevation myocardial infarction: a meta-analysis of randomized trials. Int J Cardiol 133:213–222

    Article  PubMed  Google Scholar 

  11. Qarawani D, Nahir M, Abboud M, Hazanov Y, Hasin Y (2008) Culprit only versus complete coronary revascularization during primary PCI. Int J Cardiol 123(3):288–292

    Article  PubMed  Google Scholar 

  12. Politi L, Sgura F, Rossi R, Monopoli D, Guerri E, Leuzzi C, Bursi F, Sangiorgi GM, Modena MG (2010) Multivessel coronary disease in ST-elevation myocardial infarction: three different revascularization strategies and long-term outcomes. Heart 96:662–667

    Article  PubMed  Google Scholar 

  13. Corpus RA, House JA, Marso SP, Grantham JA, Huber KC Jr, Laster SB, Johnson WL, Daniels WC, Barth CW, Giorgi LV, Rutherford BD (2004) Multivessel percutaneous coronary intervention in patients with multivessel disease and acute myocardial infarction. Am Heart J 148:493–500

    Article  PubMed  Google Scholar 

  14. Hannan EL, Samadashvili Z, Walford G, Holmes DR Jr, Jacobs AK, Stamato NJ, Venditti FJ, Sharma S, King SB 3rd (2010) Culprit vessel percutaneous coronary intervention versus multivessel and staged percutaneous coronary intervention for ST-segment elevation myocardial infarction patients with multivessel disease. JACC Cardiovasc Interv 3:22–31

    Article  PubMed  Google Scholar 

  15. The Cochrane Collaboration. Cochrane handbook for systematic reviews of interventions. www.cochrane.org/resources/handbook/ (updated February 2010)

  16. Stroup DF, Berlin JA, Morton SC et al (2000) Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis of observational studies in epidemiology (MOOSE) group. JAMA 283:2008–2012

    Article  CAS  PubMed  Google Scholar 

  17. Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gotzsche PC, Ioannidis JP, Clarke M, Devereaux PJ, Kleijnen J, Moher D (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ 339:2700

    Article  Google Scholar 

  18. Higgins JP, Thompson SG, Deeks JJ, Altman DG (2003) Measuring inconsistency in meta-analyses. BMJ 327:557–560

    Article  PubMed  Google Scholar 

  19. Fleiss JL (1986) Analysis of data from multiclinics trials. Control Clin Trials 7:267–275

    Article  CAS  PubMed  Google Scholar 

  20. Egger M, Smith GD (1998) Bias in location and selection of studies. BMJ 31:61–66

    Google Scholar 

  21. Sharp SJ, Thompson SG, Altman DG (1996) The relation between treatment benefit and underlying risk in meta-analysis. BMJ 313:735–738

    CAS  PubMed  Google Scholar 

  22. van Houwelingen HC, Arends LR, Stijnen T (2002) Advanced methods in meta-analysis: multivariate approach and meta-regression. Stat Med 21:589–624

    Article  PubMed  Google Scholar 

  23. Goldstein JA, Demetriou D, Grines CL et al (2000) Multiple complex coronary plaques in patients with acute myocardial infarction. N Engl J Med 343:915–922

    Article  CAS  PubMed  Google Scholar 

  24. Ambrose JA (2008) In search of the ‘‘vulnerable plaque’’: can it belocalized and will focal regional therapy ever be an option for cardiac prevention? J Am Coll Cardiol 51:1539–1542

    Article  PubMed  Google Scholar 

  25. Hanratty CG, Koyama Y, Rasmussen HH, Nelson GI, Hansen PS, Ward MR (2002) Exaggerationof non culprit stenosis severity during acute myocardial infarction: implications for immediate multivessel revascularization. J Am Coll Cardiol 4(40):911–916

    Article  Google Scholar 

  26. Di Mario C, Mara S, Flavio A, Imad S, Antonio M, Anna P et al (2004) Single vs multivessel treatment during primary angioplasty: results of the multicentre randomised HEpacoat forcuLPrit or multivessel stenting for Acute Myocardial Infarction (HELPAMI) Study. Int J Cardiovasc Intervent 6:128–133

    PubMed  Google Scholar 

  27. Cavender MA, Milford-Beland S, Roe MT, Peterson ED, Weintraub WS, Rao SV (2010) Prevalence, predictors, and in-hospital outcomes of non-infarct artery intervention during primary percutaneous coronary intervention for ST-segment elevation myocardial infarction (from the National Cardiovascular Data Registry). Am J Cardiol 105:955–959

    Article  Google Scholar 

  28. Khattab AA, Abdel-Wahab M, Röther C, Liska B, Toelg R, Kassner G, Geist V, Richardt G (2008) Multi-vessel stenting during primary percutaneous coronary intervention for acute myocardial infarction. A single-center experience. Clin Res Cardiol 97:32–38

    Article  CAS  PubMed  Google Scholar 

  29. Mohamad T, Bernal JM, Kondur A, Hari P, Nelson K, Niraj A, Badheka A, Hassna S, Kiernan T, Elder MD, Gardi D, Schreiber T (2010) Coronary revascularization strategy for ST elevation myocardial infarction with multivessel disease: experience and results at 1-year follow-up. Am J Ther. doi:10.1097/MJT.0b013e3181b809ee

  30. Roe MT, Cura FA, Joski PS, Garcia E, Guetta V, Kereiakes DJ, Zijlstra F, Brodie BR, Grines CL, Ellis SG (2001) Initial experience with multivessel percutaneous coronary intervention during mechanical reperfusion for acute myocardial infarction. Am J Cardiol 88:170–173 A6

    Article  CAS  PubMed  Google Scholar 

  31. Varani E, Balducelli M, Aquilina M, Vecchi G, Hussien MN, Frassineti V, Maresta A (2008) Single or multivessel percutaneous coronary intervention in ST-elevation myocardial infarction patients. Catheter Cardiovasc Interv 72:934–936

    Article  Google Scholar 

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Authors and Affiliations

  1. Division of Cardiology, Ospedale “Maggiore della Carità”, Eastern Piedmont University, Novara, Italy

    Eliano Pio Navarese & Giuseppe De Luca

  2. Department of Cardiovascular Diseases, Civic Hospital, Legnano, Italy

    Stefano De Servi

  3. Department of Cardiology, Catholic University of Sacred Heart, Rome, Italy

    Antonino Buffon

  4. Division of Cardiology, De Weezenlanden Hospital, Zwolle, The Netherlands

    Harry Suryapranata

  5. Chief Interventional Cardiology, Ospedale “Maggiore della Carità”, Eastern Piedmont University, C.so Mazzini, 18, 24100, Novara, Italy

    Giuseppe De Luca

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  1. Eliano Pio Navarese
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  2. Stefano De Servi
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  3. Antonino Buffon
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  4. Harry Suryapranata
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  5. Giuseppe De Luca
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Correspondence to Giuseppe De Luca.

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Navarese, E.P., De Servi, S., Buffon, A. et al. Clinical impact of simultaneous complete revascularization vs. culprit only primary angioplasty in patients with st-elevation myocardial infarction and multivessel disease: a meta-analysis. J Thromb Thrombolysis 31, 217–225 (2011). https://doi.org/10.1007/s11239-010-0510-4

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