麻豆传媒

ST-segment elevation myocardial infarction (STEMI) patients with multiple lesions fare at least as well with multivessel percutaneous coronary intervention (PCI) as when tackling only the culprit lesion, a study and meta-analysis found.

In the Nationwide Inpatient Sample, intervention on nonculprit lesions was associated with than was single-vessel PCI (1.91% versus 5.32%, P<0.001) after propensity matching, , of the Hospital of the University of Pennsylvania in Philadelphia, and colleagues wrote online in Catheterization and Cardiovascular Interventions.

A meta-analysis of 19 observational studies in the same paper showed in-hospital mortality equally likely between multivessel versus culprit artery-only revascularization (odds ratio 0.87, 95% CI 0.65-1.17).

"Multivessel PCI is uncommonly performed during index hospitalization in hemodynamically stable STEMI patients, likely reflecting widespread adherence to prior guidelines. Based on observational data, there does not appear to be early harm associated with multivessel PCI on the index admission in hemodynamically stable STEMI patients," Giri's group concluded.

"This contradicts conclusions from prior meta-analyses as well as prior guideline recommendations based largely on observational data," they wrote.

"All prior guidelines published between 2001 and 2013 had implied early harm with multivessel PCI for STEMI. However, we were unable to find a point in time at which this was supported by the published observational data upon which the guidelines were heavily based."

Giri's observational investigation included 11,454 multivessel PCI patients and 157,011 of their single-vessel PCI counterparts. Data from 2009 to 2012 were collected from the Nationwide Inpatient Sample (NIS). There were 19 observational studies with a total of 76,399 patients in the meta-analysis.

"Prior analyses pointing to early harm with multivessel PCI may have suffered from treatment-selection bias, with the sickest patients treated with more aggressive revascularization," the researchers noted. "We attempted to reduce the effect of treatment selection bias within our NIS analysis through exclusion of patients in cardiogenic shock and utilization of propensity-matching among the remainder of the examined cohort."

Giri's group concluded that their results support the recent guideline update that removed the designation of 'potentially harmful' for the practice of early multivessel in STEMI patients.

But while this strategy may be reasonable in some cases, it remains to be seen whether immediate or staged multivessel PCI is preferable, the authors noted.

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