Abstract

JACC

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TCTAP A-006 . Presentation

Presenter

Mengjin Hu

Authors

Mengjin Hu1, Yuejin Yang1

Affiliation

Fuwai Hospital, China1
View Study Report
TCTAP A-006
Acute Coronary Syndromes (STEMI, NSTE-ACS)

The Optimal Percutaneous Coronary Intervention Strategy for Patients with ST-segment Elevation Myocardial Infarction and Multivessel Coronary Artery Disease: A Pairwise and Network Meta-analysis of Randomized Trials

Mengjin Hu1, Yuejin Yang1

Fuwai Hospital, China1

Background

Recent randomized trials and meta-analysis have suggested that multivessel PCI is associated with better outcomes, however, the option of multivessel PCI strategy is still unknown. 

Methods

Trials that randomized patients with STEMI and multivessel coronary artery disease to any combination of the three different revascularization strategies [immediate multivessel PCI, staged multivessel PCI, or culprit-only PCI] were included. Random effect risk ratio (RR) and 95% confidence interval (CI) were conducted. Network meta-analysis was constructed using mixed treatment comparison models, and the three revascularization strategies were compared.


Results

A total of 13 trials with 7627 patients were included. In the pairwise meta-analysis, a multivessel PCI strategy (immediate or staged) was associated with a lower risk of major adverse cardiac events (MACE) (RR: 0.58; 95% CI: 0.45 to 0.74) compared with a culprit-only PCI strategy, which was mainly due to lower risks of myocardial infarction (RR: 0.67; 95% CI: 0.51 to 0.88) and revascularization (RR: 0.38; 95% CI: 0.28 to 0.51). There was also a trend toward a lower risk of all-cause death with a multivessel PCI strategy (RR: 0.85; 95% CI: 0.69 to 1.04). Safety outcomes including major bleeding, renal failure, and stroke were similar between a multivessel PCI strategy versus a culprit-only PCI strategy. The reduction in the risk of MACE, myocardial infarction, and revascularization was observed irrespective of the strategy of multivessel PCI in the mixed treatment model.


Conclusion

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TCTAP 2021 Virtual Apr 12, 2021
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