Faculty Opinions recommendation of Meta-Analysis Comparing Complete Revascularization Versus Infarct-Related Only Strategies for Patients With ST-Segment Elevation Myocardial Infarction and Multivessel Coronary Artery Disease.

2016 ◽  
Author(s):  
Wilbert Aronow
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Meta Analysis ◽  
Complete Revascularization ◽  
Multivessel Coronary Artery Disease ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
Artery Disease

CASE OF AORTOCORONARY BYPASS SURGERY IN A PATIENT WITH ST-SEGMENT ELEVATION MYOCARDIAL INFARCTION, MULTIVESSEL CORONARY LESIONS AND LOW EJECTION FRACTION

2021 ◽  
pp. 95-100
Author(s):  
Jalilov A.K.
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Coronary Artery Bypass ◽  
Multivessel Coronary Artery Disease ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
Artery Disease

For decades, coronary artery bypass grafting (CABG) has been the main method of myocardial revascularization in patients with coronary artery disease, including those with acute coronary syndrome (ACS). Over the past decades, with the development of endovascular interventions and the development of drug-eluting stents, percutaneous coronary intervention (PCI) has become the main method of revascularization after ACS. [1,6]. Acute coronary syndrome (ACS) includes clinical manifestations such as unstable angina pectoris (NS), acute non-ST-segment elevation myocardial infarction (STEMI), and ST-segment elevation myocardial infarction (STEMI). Approximately 40% of all patients diagnosed with ACS have multivessel coronary artery disease, for which coronary artery bypass grafting (CABG) is better than PCI. [2]. The majority of studies comparing PCI and CABG have mainly included patients with stable coronary artery disease who underwent planned myocardial revascularization, rather than those requiring emergency or urgent myocardial revascularization. Thus, the results of these studies have limited applicability to patients with ACS. However, the long-term results of these studies, in particular the low need for re-revascularization, a lower rate of re-myocardial infarction, and the survival benefits of CABG, still need to be considered when determining the best course of treatment for ACS. The current recommendations for treatment in most patients with ACS give preference to early revascularization using PCI or CABG [3, 4]. Thus, our main goal here is to provide the current indications and options for surgical revascularization of the coronary arteries, including current guidelines and the latest published literature. In STEMI patients, early PCI of the main lesion remains the gold standard because it provides the fastest revascularization of the ischemic myocardium and is generally better tolerated than emergency CABG [5]. Since up to 50% of STEMI patients have multivessel coronary artery disease, early arterial revascularization without myocardial infarction has been recommended to provide optimal opportunities for myocardial rescue, reduction of ischemic watershed and improvement of left ventricular function [6,7]. A clinical case of successful beating coronary artery bypass grafting in a patient with ST-segment elevation myocardial infarction, multivessel coronary artery disease and low ejection fraction. The patient was discharged on the 11th day after surgery without complications.

Complete revascularization for patients with multivessel coronary artery disease and ST-segment elevation myocardial infarction after the COMPLETE trial: a meta-analysis of randomized controlled trial

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
G Bajraktari ◽  
I Bytyci ◽  
M.Y Henein ◽  
F Alfonso ◽  
A Ahmed ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Meta Analysis ◽  
Total Mortality ◽  
Complete Revascularization ◽  
Multivessel Coronary Artery Disease ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
Randomized Controlled ◽  
St Segment ◽  
Artery Disease

Abstract Background The recently published COMPLETE trial has demonstrated that patients with ST-segment elevation myocardial infarction (STEMI) and multivessel coronary artery disease (MVD), who underwent successful percutaneous coronary intervention (PCI) of both culprit and non-culprit (vs. culprit-only) lesion had a reduced risk of major adverse cardiac events (MACE: cardiovascular mortality, myocardial infarction, or ischemia-driven revascularization), but not of cardiovascular or total mortality. Aim To assess the efficacy of complete revascularization for cardiovascular or total mortality reduction by meta-analysis of all available randomized controlled trials (RCTs) including the COMPLETE trial. Methods PubMed, MEDLINE, Embase, Scopus, Google Scholar, CENTRAL and ClinicalTrials.gov databases search identified 10 RCTs of 7033 patients with STEMI and MVD which compared complete (n=3420) vs. only culprit lesion (n=3613) PCI for a median 28.7 months follow-up. Random effect risk ratios were used for efficacy and safety outcomes. Results Complete revascularization reduced the risk of MACE (10.4% vs. 16.6%; RR=0.59, 95% CI: 0.47 to 0.74, p<0.0001), CV mortality (2.87% vs. 3.72%; RR=0.73, 95% CI: 0.56 to 0.95, p=0.02), reinfarction (5.1% vs. 7.1%; RR=0.67, 95% CI: 0.52 to 0.86, p=0.002), urgent revascularization (7.92% vs. 17.4%; RR=0.47, 95% CI: 0.30 to 0.73, p<0.001), and CV hospitalization (8.68% vs. 11.4%; RR=0.65, 95% CI: 0.44to 0.96, p=0.03) compared with culprit only revascularization. All-cause mortality, stroke, major bleeding events, or contrast induced nephropathy were not affected by the revascularization strategy. Conclusion The findings of this meta-analysis suggest that in patients with STEMI and MVD, complete revascularization is superior to culprit-only PCI in reducing the risk of MACE outcomes, including cardiovascular mortality, without increasing the risk of adverse safety outcomes. Funding Acknowledgement Type of funding source: None

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