Introduction: ST-segment elevation myocardial infarction (STEMI) in patients with co-existing multivessel (MV) coronary artery disease (CAD) is associated with poor outcomes. The benefits of non-infarct related percutaneous coronary intervention (PCI) as compared to culprit lesion only (CLO) approach is still uncertain. The recently published Compare-Acute study with 885 patients showed that fractional flow reserve guided complete revascularization of non-infarct related arteries in the acute setting resulted in lower risk of composite cardiovascular outcomes compared to CLO approach.
Objective: Our objective was to gain better understanding of the efficacy and safety of CLO compared to non-infarct related PCI in patients with STEMI by conducting an updated meta-analysis.
Methods: A comprehensive search of PubMed, EMBASE and Google Scholar databases of randomized controlled trials (RCTs) was performed. Published data were extracted from each study and pooled using a random effects model to calculate pooled risk ratios (RR) and 95% confidence intervals (95% CI).
Results: A total of 9 studies with 2989 patients were included. We found a significant difference favoring non-infarct related PCI during STEMI in terms of major adverse cardiovascular events (MACE) (RR: 0.54, 95% CI: 0.41 - 0.71, P: < 0.001). This was primarily driven by the need for urgent revascularization (RR: 0.43, 95% CI: 0.30 - 0.59, P: < 0.001) and rates of re-infarction (RR: 0.55, 95% CI: 0.32 - 0.94, p = 0.030). However, there was no difference in terms of all-cause mortality (RR: 0.77, 95% CI: 0.54 - 1.10, P: 0.149) (Fig. 1)
Conclusions: In patients with acute STEMI, a strategy of preventive PCI of non-infarct related artery during the index procedure has significant advantages in terms of reduction of MACE, urgent revascularization and re-infarction. There was, however, no significant benefit in terms of all-cause mortality.