Timing of multivessel revascularization in stable patients with STEMI: a systematic review and network meta-analysis

Felix Voll; Constantin Kuna; Maria Scalamogna; Thorsten Kessler; Sebastian Kufner; Tobias Rheude; Hendrik B Sager; Erion Xhepa; Jens Wiebe; Michael Joner; Robert A Byrne; Heribert Schunkert; Gjin Ndrepepa; Barbara E Stähli; Adnan Kastrati; Salvatore Cassese

doi:10.1016/j.rec.2024.06.002

Timing of multivessel revascularization in stable patients with STEMI: a systematic review and network meta-analysis

Rev Esp Cardiol (Engl Ed). 2024 Jun 25:S1885-5857(24)00193-2. doi: 10.1016/j.rec.2024.06.002. Online ahead of print.

[Article in English, Spanish]

Authors

Felix Voll¹, Constantin Kuna¹, Maria Scalamogna², Thorsten Kessler³, Sebastian Kufner¹, Tobias Rheude¹, Hendrik B Sager³, Erion Xhepa¹, Jens Wiebe¹, Michael Joner³, Robert A Byrne⁴, Heribert Schunkert³, Gjin Ndrepepa¹, Barbara E Stähli⁵, Adnan Kastrati³, Salvatore Cassese⁶

Affiliations

¹ Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany.
² Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany; Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy.
³ Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany; Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK), Munich, Germany.
⁴ Cardiovascular Research Institute Dublin and Department of Cardiology, Mater Private Network, Dublin, Ireland; School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons of Ireland University of Medicine and Health Sciences, Dublin, Ireland.
⁵ Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland.
⁶ Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany. Electronic address: cassese@dhm.mhn.de.

PMID: 38936467
DOI: 10.1016/j.rec.2024.06.002

Abstract

Introduction and objectives: Multivessel percutaneous coronary intervention (MV-PCI) is recommended in patients with ST-segment elevation myocardial infarction (STEMI) and multivessel coronary artery disease (CAD) without cardiogenic shock. The present network meta-analysis investigated the optimal timing of MV-PCI in this context.

Methods: We pooled the aggregated data from randomized trials investigating stable STEMI patients with multivessel CAD treated with a strategy of either MV-PCI or culprit vessel-only PCI. The primary outcome was all-cause death. The main secondary outcomes were cardiovascular death, myocardial infarction, and unplanned ischemia-driven revascularization.

Results: Among 11 trials, a total of 10 507 patients were randomly assigned to MV-PCI (same sitting, n=1683; staged during the index hospitalization, n=3460; staged during a subsequent hospitalization within 45 days, n=3275) or to culprit vessel-only PCI (n=2089). The median follow-up was 18.6 months. In comparison with culprit vessel-only PCI, MV-PCI staged during the index hospitalization significantly reduced all-cause death (risk ratio, 0.73; 95%CI, 0.56-0.92; P=.008) and ranked as possibly the best treatment option for this outcome compared with all other strategies. In comparison with culprit vessel-only PCI, a MV-PCI reduced cardiovascular mortality without differences dependent on the timing of revascularization. MV-PCI within the index hospitalization, either in a single procedure or staged, significantly reduced myocardial infarction and unplanned ischemia-driven revascularization, with no significant difference between each other.

Conclusions: In patients with STEMI and multivessel CAD without cardiogenic shock, multivessel PCI within the index hospitalization, either in a single procedure or staged, represents the safest and most efficacious approach. The different timings of multivessel PCI did not result in any significant differences in all-cause death. This study is registered at PROSPERO (CRD42023457794).

Keywords: Coronary artery disease; Enfermedad coronaria; Infarto de miocardio; Intervención coronaria percutánea; Meta-analysis; Metanálisis; Multivaso; Multivessel; Myocardial infarction; Percutaneous coronary intervention.