International Journal of General Medicine (Jun 2021)

Complete Revascularization of Stable STEMI Patients Offers a Significant Benefit if Done During the Index PCI, but Not if It’s Done as a Staged Procedure

  • Cerrud-Rodriguez RC,
  • Rashid SMI,
  • Wiley KA,
  • Gonzalez M,
  • Kosmacheva VA,
  • Castillero-Norato I,
  • Rivera C,
  • Villablanca P,
  • Wiley J

Journal volume & issue
Vol. Volume 14
pp. 2239 – 2248

Abstract

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Roberto C Cerrud-Rodriguez,1 Syed Muhammad Ibrahim Rashid,1 Karlo A Wiley,1 Maday Gonzalez,1 Valeriia A Kosmacheva,1 Isabella Castillero-Norato,2 Cornelia Rivera,1 Pedro Villablanca,3 Jose Wiley1 1Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA; 2Facultad de Medicina, Universidad de Panamá, Campus Octavio Méndez Pereira, Panama City, Republic of Panama; 3Department of Medicine, Division of Cardiology, Henry Ford Hospital, Detroit, MI, USACorrespondence: Roberto C Cerrud-RodriguezMontefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210th Street, Bronx, NY, 10467, USATel +1 718-920-7929Email [email protected]: Complete revascularization (CR) of hemodynamically stable STEMI improves outcomes when compared to culprit-only PCI. However, the optimal timing for CR (CR during index PCI [iCR] versus staged PCI [sCR]) is unknown. sCR is defined as revascularization of non-culprit lesions not done during the index procedure (mean 31.5± 24.6 days after STEMI). Our goal was to determine whether iCR was the superior strategy when compared to sCR.Methods: A systematic review of Medline, Cochrane, and Embase was performed for RCTs reporting outcomes of stable STEMI patients who had undergone CR. Only RCTs with a clearly defined timing of CR, for the classification into iCR and sCR, and a follow-up of at least 12 months were included. Seven RCTs comprising 6647 patients (mean age:62.9± 1.4 years, male sex:79.4%) met these criteria and were included.Results: After a mean follow-up of 25.1± 9.4 months, iCR was associated with a significant reduction in cardiovascular mortality (risk ratio [RR] 0.48, 95% confidence interval [CI] 0.26– 0.90, p=0.02, relative risk reduction [RRR] 52%) and non-fatal reinfarctions (RR 0.42, 95% CI 0.25– 0.70, p=0.001, RRR: 58%). sCR showed a significant reduction in non-fatal reinfarctions only (RR 0.68, 95% CI 0.54– 0.85, p=0.0008, RRR: 32%). There was no difference in the safety outcome of contrast-induced nephropathy between groups.Conclusion: iCR of stable STEMI patients is associated with a significant reduction in cardiovascular death and a trend towards reduction in all-cause mortality. These benefits are not seen in sCR. Both strategies are associated with a reduction in non-fatal reinfarctions.Keywords: ST-segment elevation myocardial infarction, STEMI, percutaneous coronary intervention, PCI, staged revascularization, complete revascularization.

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