Coronary disease & ACS

Percutaneous Coronary Revascularization Strategies After Myocardial Infarction: A Systematic Review and Network Meta-Analysis

J Am Coll CardiolPublished Systematic review and network meta-analysis of randomised trials

Pooled result · All-cause mortality (any MI)Result — go to the resultRelative risk 0.85 95% CI 0.74–0.99

Authors' conclusion

Complete revascularization following MI reduces all-cause mortality, cardiovascular mortality, MI, major adverse cardiac events, and repeat revascularization.

Study context

Population
Patients with myocardial infarction (MI) and multivessel CAD
Participants
16,371 patients24 RCTs
Comparison
Complete vs culprit-only revascularization
Outcome
All-cause mortality
Methodological detailsfrequentist and Bayesian network meta-analyses
  • Frequentist and Bayesian network meta-analyses

Pooled result

All-cause mortality (any MI) · weighted mean follow-up 26.4 months

Relative risk

0.85

95% CI 0.74–0.99

P = 0.04

Complete revascularizationvs Culprit revascularization
RR 0.85 (95% CI 0.74–0.99); P = 0.04

As reported in the abstract

Further pooled results

OutcomeRR (95% CI)P value
All-cause mortality, STEMI (subgroup)0.91 (0.78–1.05)P = 0.18

CV mortality, MI, MACE, repeat revascularization

Also significantly reduced with complete revascularization

Timing of complete revascularization

Immediate ranked higher than staged complete revascularization for all endpoints

Safety

Stent thrombosis, major bleeding, AKI

Rates similar

Original publication

Percutaneous Coronary Revascularization Strategies After Myocardial Infarction: A Systematic Review and Network Meta-Analysis. J Am Coll Cardiol. Published 16 July 2024. doi:10.1016/j.jacc.2024.04.051

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