Recent trials and meta-analysis have indicated that complete revascularization (CR)
of multivessel coronary disease is beneficial in patients with ST-segment elevation
myocardial infarction (STEMI) compared to culprit-only intervention. However, the
optimal timing of CR remains unclear. We aimed to analyze the optimal timing of CR
in patients with STEMI and multivessel disease by performing an updated network meta-analysis
using the recent largest randomized controlled trial. PUBMED and EMBASE were searched
through October 2020 to identify randomized controlled trials comparing CR and culprit-only
revascularization. A random-effect network meta-analysis comparing three arms (same-sitting
[during the index procedure] CR versus staged CR versus culprit-only) and 4 arms (same-sitting
CR versus staged CR [in-hospital] versus staged CR [out-hospital] versus culprit-only)
were performed. Eleven studies with a total of 7,015 patients were included in our
analysis. There was no significant difference in major adverse cardiovascular event
(MACE) (HR 0.82, 95% CI 0.64-1.05), cardiovascular death (HR 0.69, 95%CI 0.35-1.33),
myocardial infarction (HR 0.66, 95%CI 0.37-1.16), and revascularization (HR 1.05,
95%CI 0.70-1.58) between same-sitting CR and staged CR. When staged CR was further
divided into staged CR during the hospitalization and after discharge, there was no
significant difference in these outcomes between staged CR (in-hospital) and staged
CR (out-hospital). In conclusion, in patients with multivessel disease presenting
with STEMI, complete revascularization at any timing, including same-sitting, staged
in-hospital, and staged out-hospital, may have similar benefits.
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Article info
Publication history
Published online: May 16, 2021
Received in revised form:
March 24,
2021
Received:
January 25,
2021
Footnotes
Pieter C. Smits: received institutional research grants from Abbott Vascular and St. Jude Medical.
All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
Acknowledgements: None
Identification
Copyright
© 2021 Published by Elsevier Inc.
