Abstract
Percutaneous coronary intervention (PCI) is preferred in patients with acute ST-elevation myocardial infarction (STEMI). In patients with acute STEMI with multivessel disease (MVD), the guidelines recommend culprit vessel PCI (CV-PCI) in the absence of hemodynamic instability. We performed a meta-analysis of all randomized controlled trials (RCTs) comparing multi-vessel PCI (MV-PCI) with CV-PCI or staged PCI (S-PCI) in patients with acute STEMI and MVD. Methods: PubMed, EMBASE and CENTRAL were searched for publications since inception to December 2013. Random effects model was used to compute summary effects. Results: Four RCTs (840 patients) were identified. MV-PCI compared to CV-PCI significantly reduced the risks of major adverse cardiac events (MACE)-a composite of MI, revascularization and all-cause mortality (RR: 0.46, 95% CI: 0.35-0.60, P. <. 0.00001) by reducing the risks of MI (0.35, 0.17-0.71, P. =. 0.004) and revascularization (0.35, 0.24-0.52, P. <. 0.00001). The risk of all-cause mortality was not different (0.69, 0.39-1.21, P. =. 0.19). S-PCI and MV-PCI had similar risks of MACE (0.96, 0.59-1.57, P. =. 0.87), MI (0.60, 0.20-1.78, P. =. 0.36), revascularization (0.86, 0.47-1.54, P. =. 0.60) and all-cause mortality (1.50, 0.44-5.07, P. =. 0.57). Conclusions: MV-PCI compared to CV-PCI resulted in lower risks of MACE driven by lower MI and revascularization in patients with STEMI and multi-vessel disease.