TY  - BOOK
AU  - Azizi, Viana
AU  - Beyene, Solomon
AU  - Brathwaite, Echo J
AU  - Dan, Kazuhiro
AU  - Desale, Sameer
AU  - Dheendsa, Aaphtaab
AU  - Garcia-Garcia, Hector M
AU  - Hideo-Kajita, Alexandre
AU  - Kuku, Kayode
AU  - Lipinski, Michael
AU  - Meirovich, Yael F
AU  - Melaku, Gebremedhin
AU  - Ozaki, Yuichi
AU  - Soud, Mohammad
AU  - Waksman, Ron
TI  - Clinical outcomes of complete revascularization using either angiography-guided or fractional flow reserve-guided drug-eluting stent implantation in non-culprit vessels in ST elevation myocardial infarction patients: insights from a study based on a systematic review and meta-analysis. [Review]
SN  - 1569-5794
PY  - 2018///
KW  - *Coronary Artery Disease/th [Therapy]
KW  - *Drug-Eluting Stents
KW  - *Myocardial Revascularization/mt [Methods]
KW  - *Percutaneous Coronary Intervention
KW  - *ST Elevation Myocardial Infarction/th [Therapy]
KW  - Coronary Angiography
KW  - Coronary Artery Disease/co [Complications]
KW  - Coronary Artery Disease/dg [Diagnostic Imaging]
KW  - Coronary Artery Disease/pp [Physiopathology]
KW  - Fractional Flow Reserve, Myocardial
KW  - Humans
KW  - ST Elevation Myocardial Infarction/dg [Diagnostic Imaging]
KW  - ST Elevation Myocardial Infarction/et [Etiology]
KW  - ST Elevation Myocardial Infarction/pp [Physiopathology]
KW  - Treatment Outcome
KW  - MedStar Heart & Vascular Institute
KW  - Journal Article
KW  - Review
N2  - Current guidelines recommend that percutaneous coronary intervention (PCI) should be restricted to the culprit vessel in ST elevation myocardial infarction (STEMI) patients with multi-vessel disease (MVD) and without cardiogenic shock. However, newer data suggests that performing complete revascularization (CR) in MVD patients may lead to better outcomes compared to intervention in the culprit vessel only. The aim of this meta-analysis is to examine the available data to determine if CR (using either angio- or fractional flow reserve guidance-FFR) following primary PCI in STEMI patients without cardiogenic shock impacts clinical outcomes. Meta-analysis was performed by conducting a literature search of PubMed from January 2004 to July 2017. Pooled estimates of outcomes, presented as odds ratios (OR) [95% confidence intervals], were generated using random-effect models. A total of 9 studies (3317 patients) were included. CR showed a significant MACE reduction (OR 0.49, 95% CI 0.36-0.66, p<0.001); All-cause mortality (OR 0.69, 95% CI 0.48-0.98, p=0.04) and repeat revascularization (OR 0.38, 95% CI 0.28-0.51, p<0.001) at>=12 months follow-up. The FFR-guiding CR group presented a MACE reduction (odds ratio 0.52, 95% CI 0.30-0.90, p=0.02) due to a decrease of repeat revascularization (OR 0.41, 95% CI 0.21-0.80, p=0.009). Overall, performing complete revascularization in STEMI patients showed a MACE reduction, all-cause death and repeat revascularization. Compared to culprit-only revascularization, treating multi-vessel disease in STEMI patients using FFR guidance is associated with decreased incidence of MACE, due to a decreased rate of revascularization
UR  - https://dx.doi.org/10.1007/s10554-018-1362-9
ER  -