Vol. 43 | No. 1 | January-June 2015 Back

Open Access

Complete Percutaneous Coronary Intervention versus Culprit Only Percutaneous Coronary Intervention for Acute ST Elevation Myocardial Infarction with Multivessel Coronary Artery Disease: A Meta-analysis

Lorraine Grace B. Almelor, Cheryl K. Fomaneg, Aleano L. Dayag, Paul Ferdinand M. Reganit
Jun 2015 DOI 10.69944/pjc.303beab87c

Abstract

BACKGROUND: Current guidelines recommend that primary percutaneous coronary intervention (PCI) in hemodynamically stable acute ST-elevation myocardial infarction (STEMI) patients should be limited to the culprit vessel despite significant stenosis in nonculprit coronary arteries. Recent studies and meta-analyses provide conflicting data. 

OBJECTIVES: This review compared the efficacy of culprit (infarctrelated artery only) primary PCI versus complete (infarctrelated artery and at least one other artery with significant stenosis) primary PCI in acute STEMI patients with multivessel coronary artery disease (CAD). 

METHODS: We systematically searched the electronic databases, MEDLINE and CENTRAL, and the clinical trial registries, ClinicalTrials.gov and ISRCTN registry, for all published and unpublished randomized controlled trials (RCTs) comparing culprit primary PCI versus complete primary PCI in acute STEMI with multivessel CAD. Manual searching was done by reviewing the references of available studies. Data were extracted from full text reports of eligible trials, and evaluated independently by the authors using the Cochrane Collaboration’s tool for assessing risk of bias. Statistical analyses were performed using RevMan 5.3. 

RESULTS: Four RCTs (3 published,1 unpublished) involving 979 patients were analyzed. Complete PCI was associated with a decreased risk for both cardiovascular (RR 0.45 [95% CI 0.22, 0.94]; p=0.03) and all cause mortality (RR 0.63 [95% CI 0.37, 1.05]; p=0.08), as well as repeat revascularization (RR 0.37 [95% CI 0.26, 0.53]; p<0.00001) and repeat non-fatal myocardial infarction (MI) (RR 0.37 [95% CI 0.19, 0.71]; p=0.003). No heterogeneity was detected (I2 statistic was 0% for all outcomes). 

CONCLUSION: Complete PCI is associated with a significant decrease in the risk of cardiovascular mortality, repeat revascularization and repeat nonfatal MI in patients with acute STEMI and multivessel CAD.

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