Complete Revascularization of the Patient with ST-Segment–Elevation Myocardial Infarction

2020 ◽  
pp. 1-4
Keyword(s):  
Myocardial Infarction ◽  
Complete Revascularization ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment

scholarly journals Complete Revascularization Versus Culprit Lesion Only in Patients With ST-Segment Elevation Myocardial Infarction and Multivessel Disease

2019 ◽  
Vol 12 (8) ◽  
pp. 721-730 ◽  
Author(s):  
Kasper Kyhl ◽  
Kiril Aleksov Ahtarovski ◽  
Lars Nepper-Christensen ◽  
Kathrine Ekström ◽  
Adam Ali Ghotbi ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Multivessel Disease ◽  
Complete Revascularization ◽  
Culprit Lesion ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment

scholarly journals Complete revascularization reduces cardiovascular death in patients with ST-segment elevation myocardial infarction and multivessel disease: systematic review and meta-analysis of randomized clinical trials

2019 ◽  
Vol 41 (42) ◽  
pp. 4103-4110 ◽  
Author(s):  
Rita Pavasini ◽  
Simone Biscaglia ◽  
Emanuele Barbato ◽  
Matteo Tebaldi ◽  
Dariusz Dudek ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Clinical Trials ◽  
Randomized Clinical Trials ◽  
Meta Analysis ◽  
Cardiovascular Death ◽  
Multivessel Disease ◽  
Complete Revascularization ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment

Abstract Aims The aim of this work was to investigate the prognostic impact of revascularization of non-culprit lesions in patients with ST-segment elevation myocardial infarction (STEMI) and multivessel disease by performing a meta-analysis of available randomized clinical trials (RCTs). Methods and results Data from six RCTs comparing complete vs. culprit-only revascularization in STEMI patients with multivessel disease were analysed with random effect generic inverse variance method meta-analysis. The endpoints were expressed as hazard ratio (HR) with 95% confidence interval (CI). The primary outcome was cardiovascular death. Main secondary outcomes of interest were all-cause death, myocardial infarction (MI), and repeated coronary revascularization. Overall, 6528 patients were included (3139 complete group, 3389 culprit-only group). After a follow-up ranging between 1 and 3 years (median 2 years), cardiovascular death was significantly reduced in the group receiving complete revascularization (HR 0.62, 95% CI 0.39–0.97, I2 = 29%). The number needed to treat to prevent one cardiovascular death was 70 (95% CI 36–150). The secondary endpoints MI and revascularization were also significantly reduced (HR 0.68, 95% CI 0.55–0.84, I2 = 0% and HR 0.29, 95% CI 0.22–0.38, I2 = 36%, respectively). Needed to treats were 45 (95% CI 37–55) for MI and 8 (95% CI 5–13) for revascularization. All-cause death (HR 0.81, 95% CI 0.56–1.16, I2 = 27%) was not affected by the revascularization strategy. Conclusion In a selected study population of STEMI patients with multivessel disease, a complete revascularization strategy is associated with a reduction in cardiovascular death. This reduction is concomitant with that of MI and the need of repeated revascularization.

scholarly journals Complete Revascularization in Patients Undergoing a Pharmacoinvasive Strategy for ST-Segment–Elevation Myocardial Infarction: Insights From the COMPLETE Trial

2021 ◽  
Author(s):  
Payam Dehghani ◽  
Warren J. Cantor ◽  
Jia Wang ◽  
David A. Wood ◽  
Robert F. Storey ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Cardiovascular Death ◽  
Hazard Ratio ◽  
Complete Revascularization ◽  
Primary Pci ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
Major Cardiovascular Events ◽  
St Segment ◽  
Artery Disease

Background: The COMPLETE trial (Complete Versus Culprit-Only Revascularization to Treat Multi-Vessel Disease After Early PCI for STEMI) demonstrated that staged nonculprit lesion percutaneous coronary intervention (PCI) reduced major cardiovascular events in patients with ST-segment–elevation myocardial infarction and multivessel coronary artery disease. It is unclear whether consistent benefit is observed in patients undergoing a pharmacoinvasive strategy compared with primary PCI. Methods: Following culprit lesion PCI, 4041 patients with ST-segment–elevation myocardial infarction and multivessel coronary artery disease were randomized to either routine nonculprit lesion PCI or culprit lesion only PCI. In a prespecified analysis, we determined the treatment effect in 303 patients undergoing a pharmacoinvasive strategy versus 3738 patients undergoing primary PCI on the first coprimary outcome of cardiovascular death or new myocardial infarction and the second coprimary outcome of cardiovascular death, new myocardial infarction, or ischemia-driven revascularization. Results: The first coprimary was reduced with complete revascularization both in the patients undergoing a pharmacoinvasive strategy (2.1%/y versus 4.7%/y, hazard ratio, 0.45 [95% CI, 0.21–0.97]) and in patients undergoing primary PCI (2.7%/y versus 3.6%/y, hazard ratio, 0.77 [95% CI, 0.62–0.95]; interaction P =0.18). The second coprimary outcome was reduced with complete revascularization in patients undergoing a pharmacoinvasive strategy (2.3%/y versus 8.5%/y, hazard ratio, 0.28 [95% CI, 0.14–0.56]), and in patients undergoing primary PCI (3.2%/y versus 6.0%/y, hazard ratio, 0.53 [95% CI, 0.44–0.64], interaction P =0.07). Conclusions: Among patients with ST-segment–elevation myocardial infarction and multivessel disease, complete revascularization with multivessel PCI consistently reduces major cardiovascular events in patients undergoing an initial pharmacoinvasive strategy as well as in those undergoing primary PCI. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT01740479.

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