Complete revascularization versus culprit-only revascularization in ST-segment elevation myocardial infarction and multivessel disease patients undergoing primary percutaneous coronary intervention: A meta-analysis and trial sequential analysis

The present study compared the outcomes of complete revascularization (CR) and culprit-only revascularization (COR) performed during primary percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI) and multivessel disease through a meta-analysis in order to determine which strategy is more appropriate. Published randomized controlled trials (RCTs) were retrieved from the PubMed, EMBASE, and CENTRAL databases. Eight RCTs with 2060 patients were selected (1080 patients underwent CR [immediate (ICR) or staged (SCR)] and 980 patients underwent COR). The follow-up was 6-38 months. In the overall population, CR reduced major adverse cardiac events (MACE) and repeat revascularization when compared to those with COR (RR 0.60, 95% CI 0.50-0.72; RR 0.49, 95% CI 0.33-0.73). In the subgroups analysis, ICR reduced MACE, all-cause death and/or MI, non-fatal MI, and repeat revascularization compared to COR (RR 0.44, 95% CI 0.32-0.60; RR 0.55, 95% CI 0.36-0.85; RR 0.35, 95% CI 0.17-0.71; RR 0.35, 95% CI 0.24-0.52; SCR reduced only MACE when compared with those in COR (RR 0.71, 95% CI 0.56-0.89). However, trial sequential analysis powered for a 25% relative reduction indicated firm evidence (cumulative z-curve crossed the monitoring boundary) for only MACE and revascularization in the overall population and ICR subgroup. Contrast-induced nephropathy, major hemorrhage, and stroke incidences were not different between CR and COR. Based on these findings, we believe that CR is preferable to COR in STEMI and multivessel disease patients undergoing primary PCI.