Clinical benefits of complete revascularisation in ST-elevation myocardial infarction and multivessel disease: A meta-analysis of randomised controlled trials

Aims: Current guidelines recommend culprit only revascularisation in haemodynamically stable patients with ST-segment elevation myocardial infarction (STEMI) and multivessel (MV) disease. Contrary to this there is a growing body of evidence available from recent randomised controlled trials (RCTs) demonstrating improved outcomes with complete MV-percutaneous coronary intervention (PCI). Methods and results: An updated meta-analysis of RCTs comparing complete MV-PCI with non-complete MV-PCI in STEMI and MV disease was performed. Multiple databases along with congress proceedings from major cardiovascular societies meetings were screened for relevant studies. The primary endpoint was the composite of major adverse cardiac events (MACE). 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 persons-years. A total of seven RCTs (N=1,303) were included. The median follow-up was 12 months. A significant 41% reduction of the odds of MACE was demonstrated with complete MV-PCI as compared to no-complete MV-PCI: OR (95% CI): 0.59 (0.36-0.97); p=0.04. This benefit was driven by a significant 52% reduction of the odds of recurrent MI: OR (95% CI): 0.48 (0.27-0.85); p=0.01 and 49% significant reduction of the odds of repeat revascularisation: OR (95% CI): 0.51 (0.31-0.84); p=0.008. Complete MV-PCI was associated with a non-significant trend towards reduced cardiovascular mortality (OR [95% CI]: 0.54 [0.26-1.10]; p=0.09). Conclusions: In STEMI and MV disease, complete MV-PCI as compared to non-complete strategy yields higher benefits on clinical events driven by a significant reduction of myocardial infarction and repeat revascularisation rates.