Multivessel versus culprit vessel only percutaneous coronary intervention in non-ST elevation myocardial infarction: Systematic review and meta-analysis.

BACKGROUND

Multivessel disease is common in non-ST elevation myocardial infarction patients. However, whether multivessel percutaneous coronary intervention is superior to culprit vessel percutaneous coronary intervention is unknown.

METHODS

A meta-analysis was conducted including studies that compared multivessel percutaneous coronary intervention (MV-PCI) and culprit vessel percutaneous coronary intervention among non-ST elevation myocardial infarction patients. Relative risk (RR) for mortality, myocardial infarction (MI), repeat revascularization and procedural complications was calculated using a random effects model. Seventeen studies were included in the meta-analysis.

RESULTS

There was no difference in short-term outcomes for mortality (RR 0.917, 95% CI 0.613-1.371, P = .672), MI (RR 0.960, 95% CI 0.612-1.507, P = .861), and stent thrombosis (RR 1.338, 95% CI 0.655-2.733, P = .424). Long-term mortality and repeat revascularization was significantly lower in the MV-PCI group (RR 0.746, 95% CI 0.644-0.865, P < .001 and RR 0.775, 95% CI 0.629-0.954, P = .016), respectively.

CONCLUSION

No significant difference was demonstrated between the 2 strategies in the short-term outcomes. However, long-term outcomes in the MV-PCI group were superior to culprit vessel percutaneous coronary intervention in non-ST elevation myocardial infarction patients with multivessel disease. Long-term outcomes included mortality, repeat revascularization, stent thrombosis, and MI. However, randomized controlled trials are needed to compare the safety and efficacy of these strategies.