Culprit vessel only versus multivessel and staged percutaneous coronary intervention for multivessel disease in patients presenting with ST-segment elevation myocardial infarction: A pairwise and network meta-analysis

Pieter J. Vlaar, Karim D. Mahmoud, David Holmes, Gert Van Valkenhoef, Hans L. Hillege, Iwan C.C. Van Der Horst, Felix Zijlstra, Bart J.G.L. De Smet

Research output: Contribution to journalArticle

225 Citations (Scopus)

Abstract

Objectives: The purposes of this study were to investigate whether, in patients with ST-segment elevation myocardial infarction (STEMI) and multivessel disease (MVD), percutaneous coronary intervention (PCI) should be confined to the culprit or also nonculprit vessels and, when performing PCI for nonculprit vessels, whether it should take place during primary PCI or staged procedures. Background: A significant percentage of STEMI patients have MVD. However, the best PCI strategy for nonculprit vessel lesions is unknown. Methods: Pairwise and network meta-analyses were performed on 3 PCI strategies for MVD in STEMI patients: 1) culprit vessel only PCI strategy (culprit PCI), defined as PCI confined to culprit vessel lesions only; 2) multivessel PCI strategy (MV-PCI), defined as PCI of culprit vessel as well as <1 nonculprit vessel lesions; and 3) staged PCI strategy (staged PCI), defined as PCI confined to culprit vessel, after which <1 nonculprit vessel lesions are treated during staged procedures. Prospective and retrospective studies were included when research subjects were patients with STEMI and MVD undergoing PCI. The primary endpoint was short-term mortality. Results: Four prospective and 14 retrospective studies involving 40,280 patients were included. Pairwise meta-analyses demonstrated that staged PCI was associated with lower short- and long-term mortality as compared with culprit PCI and MV-PCI and that MV-PCI was associated with highest mortality rates at both short- and long-term follow-up. In network analyses, staged PCI was also consistently associated with lower mortality. Conclusions: This meta-analysis supports current guidelines discouraging performance of multivessel primary PCI for STEMI. When significant nonculprit vessel lesions are suitable for PCI, they should only be treated during staged procedures.

Original languageEnglish (US)
Pages (from-to)692-703
Number of pages12
JournalJournal of the American College of Cardiology
Volume58
Issue number7
DOIs
StatePublished - Aug 9 2011

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Percutaneous Coronary Intervention
Network Meta-Analysis
ST Elevation Myocardial Infarction
Mortality
Meta-Analysis
Retrospective Studies
Research Subjects

Keywords

  • acute myocardial infarction
  • multivessel disease
  • percutaneous coronary intervention

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Culprit vessel only versus multivessel and staged percutaneous coronary intervention for multivessel disease in patients presenting with ST-segment elevation myocardial infarction : A pairwise and network meta-analysis. / Vlaar, Pieter J.; Mahmoud, Karim D.; Holmes, David; Van Valkenhoef, Gert; Hillege, Hans L.; Van Der Horst, Iwan C.C.; Zijlstra, Felix; De Smet, Bart J.G.L.

In: Journal of the American College of Cardiology, Vol. 58, No. 7, 09.08.2011, p. 692-703.

Research output: Contribution to journalArticle

Vlaar, Pieter J. ; Mahmoud, Karim D. ; Holmes, David ; Van Valkenhoef, Gert ; Hillege, Hans L. ; Van Der Horst, Iwan C.C. ; Zijlstra, Felix ; De Smet, Bart J.G.L. / Culprit vessel only versus multivessel and staged percutaneous coronary intervention for multivessel disease in patients presenting with ST-segment elevation myocardial infarction : A pairwise and network meta-analysis. In: Journal of the American College of Cardiology. 2011 ; Vol. 58, No. 7. pp. 692-703.
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T1 - Culprit vessel only versus multivessel and staged percutaneous coronary intervention for multivessel disease in patients presenting with ST-segment elevation myocardial infarction

T2 - A pairwise and network meta-analysis

AU - Vlaar, Pieter J.

AU - Mahmoud, Karim D.

AU - Holmes, David

AU - Van Valkenhoef, Gert

AU - Hillege, Hans L.

AU - Van Der Horst, Iwan C.C.

AU - Zijlstra, Felix

AU - De Smet, Bart J.G.L.

PY - 2011/8/9

Y1 - 2011/8/9

N2 - Objectives: The purposes of this study were to investigate whether, in patients with ST-segment elevation myocardial infarction (STEMI) and multivessel disease (MVD), percutaneous coronary intervention (PCI) should be confined to the culprit or also nonculprit vessels and, when performing PCI for nonculprit vessels, whether it should take place during primary PCI or staged procedures. Background: A significant percentage of STEMI patients have MVD. However, the best PCI strategy for nonculprit vessel lesions is unknown. Methods: Pairwise and network meta-analyses were performed on 3 PCI strategies for MVD in STEMI patients: 1) culprit vessel only PCI strategy (culprit PCI), defined as PCI confined to culprit vessel lesions only; 2) multivessel PCI strategy (MV-PCI), defined as PCI of culprit vessel as well as <1 nonculprit vessel lesions; and 3) staged PCI strategy (staged PCI), defined as PCI confined to culprit vessel, after which <1 nonculprit vessel lesions are treated during staged procedures. Prospective and retrospective studies were included when research subjects were patients with STEMI and MVD undergoing PCI. The primary endpoint was short-term mortality. Results: Four prospective and 14 retrospective studies involving 40,280 patients were included. Pairwise meta-analyses demonstrated that staged PCI was associated with lower short- and long-term mortality as compared with culprit PCI and MV-PCI and that MV-PCI was associated with highest mortality rates at both short- and long-term follow-up. In network analyses, staged PCI was also consistently associated with lower mortality. Conclusions: This meta-analysis supports current guidelines discouraging performance of multivessel primary PCI for STEMI. When significant nonculprit vessel lesions are suitable for PCI, they should only be treated during staged procedures.

AB - Objectives: The purposes of this study were to investigate whether, in patients with ST-segment elevation myocardial infarction (STEMI) and multivessel disease (MVD), percutaneous coronary intervention (PCI) should be confined to the culprit or also nonculprit vessels and, when performing PCI for nonculprit vessels, whether it should take place during primary PCI or staged procedures. Background: A significant percentage of STEMI patients have MVD. However, the best PCI strategy for nonculprit vessel lesions is unknown. Methods: Pairwise and network meta-analyses were performed on 3 PCI strategies for MVD in STEMI patients: 1) culprit vessel only PCI strategy (culprit PCI), defined as PCI confined to culprit vessel lesions only; 2) multivessel PCI strategy (MV-PCI), defined as PCI of culprit vessel as well as <1 nonculprit vessel lesions; and 3) staged PCI strategy (staged PCI), defined as PCI confined to culprit vessel, after which <1 nonculprit vessel lesions are treated during staged procedures. Prospective and retrospective studies were included when research subjects were patients with STEMI and MVD undergoing PCI. The primary endpoint was short-term mortality. Results: Four prospective and 14 retrospective studies involving 40,280 patients were included. Pairwise meta-analyses demonstrated that staged PCI was associated with lower short- and long-term mortality as compared with culprit PCI and MV-PCI and that MV-PCI was associated with highest mortality rates at both short- and long-term follow-up. In network analyses, staged PCI was also consistently associated with lower mortality. Conclusions: This meta-analysis supports current guidelines discouraging performance of multivessel primary PCI for STEMI. When significant nonculprit vessel lesions are suitable for PCI, they should only be treated during staged procedures.

KW - acute myocardial infarction

KW - multivessel disease

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