Timing of Complete Revascularization in Patients With STEMI and Multivessel Disease: An Updated Meta-Analysis of Randomized Clinical Trials
Authors' conclusion
In hemodynamically stable patients with ST-segment-elevation myocardial infarction and multivessel disease, an ICR strategy may increase short-term cardiac death compared with SCR, and the possibility of increased early and late all-cause mortality cannot be excluded. Despite some uncertainty, these results currently favor a staged CR strategy for most patients with ST-segment-elevation myocardial infarction and multivessel disease.
Study context
- Population
- Patients with ST-segment-elevation myocardial infarction and multivessel disease
- Participants
- 4,213 patients · 9 randomized controlled trials
- Comparison
- immediate complete revascularization (CR) versus staged CR
- Outcome
- Short-term and long-term all-cause mortality
Pooled result
As reported in the abstract
Immediate CR (ICR)
- Short-term all-cause mortality
- 2.0%
- All-cause mortality at median 1-year follow-up
- 4.7%
Staged CR (SCR)
- Short-term all-cause mortality
- 1.2%
- All-cause mortality at median 1-year follow-up
- 3.5%
Short-term all-cause mortality
All-cause mortality at median 1-year follow-up
Further pooled results
| Outcome | Risk ratio (95% CI) | P value | |
|---|---|---|---|
| Short-term cardiac death · increased after ICR; I 2 =0% | 2.19 (1.08–4.44) | P = 0.03 | |
| 0.20.5125Risk ratio (log scale) |
Myocardial infarction, repeat revascularization, stent thrombosis, stroke, major bleeding, and the composite of major adverse cardiac or cerebrovascular events · short-term or long-term follow-up
- No significant differences were identified between the ICR and SCR strategies
Original publication
Summarised from the published abstract; every number is checked against it