MedStar Authors catalog › Details for: Complete revascularisation in ST-elevation myocardial infarction and multivessel disease: meta-analysis of randomised controlled trials.
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Complete revascularisation in ST-elevation myocardial infarction and multivessel disease: meta-analysis of randomised controlled trials.

by Waksman, Ron.
Citation: Heart. 101(16):1309-17, 2015 Aug..Journal: Heart (British Cardiac Society).ISSN: 1355-6037.Full author list: Kowalewski M; Schulze V; Berti S; Waksman R; Kubica J; Kolodziejczak M; Buffon A; Suryapranata H; Gurbel PA; Kelm M; Pawliszak W; Anisimowicz L; Navarese EP.UI/PMID: 26037102.Subject(s): Coronary Artery Disease/co [Complications] | Coronary Artery Disease/pp [Physiopathology] | *Coronary Artery Disease | Electrocardiography | Humans | Myocardial Infarction/di [Diagnosis] | Myocardial Infarction/et [Etiology] | Myocardial Infarction/th [Therapy] | *Myocardial Infarction | Myocardial Revascularization/mt [Methods] | Myocardial Revascularization/st [Standards] | *Myocardial Revascularization | Outcome Assessment (Health Care) | Percutaneous Coronary Intervention/mt [Methods] | Percutaneous Coronary Intervention/mo [Mortality] | Percutaneous Coronary Intervention/sn [Statistics & Numerical Data] | *Percutaneous Coronary Intervention | Retreatment/sn [Statistics & Numerical Data] | Severity of Illness Index | Survival AnalysisInstitution(s): MedStar Heart & Vascular InstituteActivity type: Journal Article.Medline article type(s): Journal Article | Meta-AnalysisOnline resources: Click here to access online Digital Object Identifier: (Click here) Abbreviated citation: Heart. 101(16):1309-17, 2015 Aug.Local Holdings: Available online from MWHC library: 1939 - present, Available in print through MWHC library: 1996 - 2006.Abstract: BACKGROUND: Current guidelines recommend culprit-only revascularisation (COR) in haemodynamically stable patients with ST-segment elevation myocardial infarction (STEMI) and multivessel (MV) disease. Contrarily, growing body of evidence available from recent randomised controlled trials (RCTs) demonstrates improved outcomes with complete MV-percutaneous coronary intervention (PCI).Abstract: METHODS AND RESULTS: We performed a meta-analysis of RCTs comparing complete MV-PCI with non-complete MV-PCI in STEMI and MV disease. Complete MV-PCI was defined as revascularisation to non-infarct-related artery lesions during index procedure, non-complete MV-PCI-encompassed COR and staged approaches. Multiple databases and congress proceedings from major cardiovascular societies' meetings were screened for relevant studies. Primary endpoint was the composite of major adverse cardiac events (MACE) typically defined as death, recurrent myocardial infarction (MI) and repeat revascularisation. Secondary endpoints were cardiovascular mortality, recurrent MI and repeat revascularisation. Outcomes were analysed at longest available follow-up with differences accounted for with adjusted models by person-years. Seven RCTs (N=1303) were included. The median follow-up was 12 months. Complete MV-PCI reduced the odds of MACE compared with non-complete MV-PCI (OR (95% CIs) 0.59 (0.36 to 0.97), p=0.04) driven by reduction in recurrent MI (0.48 (0.27 to 0.85), p=0.01) and repeat revascularisation (0.51 (0.31 to 0.84), p=0.008). Complete MV-PCI was associated with a non-significant trend towards reduced cardiovascular mortality (0.54 (0.26 to 1.10), p=0.09) as well. In a sensitivity analysis, none of the baseline clinical variables significantly influenced overall estimates.Abstract: CONCLUSIONS: In STEMI and MV disease, complete MV-PCI as compared with non-complete strategy reduces MACE by 41%, driven by a 52% reduction in recurrent MI and 49% reduction in repeat revascularisation.Copyright Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to

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