Cardiology Department, Al-Azhar University, New Damietta, Egypt.
Cardiology Department, Menoufia University, Shebin El-Kom, Egypt.
Open Heart. 2022 Jun;9(1). doi: 10.1136/openhrt-2022-001975.
Several studies have demonstrated that complete revascularisation improves clinical outcomes in patients with ST-segment elevation myocardial infarction (STEMI) and multivessel coronary disease. However, the optimal timing of non-culprit lesion revascularisation remains controversial.
The aim of this systematic review and meta-analysis was to assess the effect of timing of complete revascularisation on cardiovascular outcomes in patients with STEMI and multivessel coronary artery disease.
Searches of PubMed, the Cochrane Library, ClinicalTrials.gov and the reference lists of relevant papers were conducted covering the period from 2004 to 2019. A pairwise analysis was performed to compare the difference in clinical outcome between early complete revascularisation (index procedure or index hospitalisation) and delayed complete revascularisation (after discharge) in patients with STEMI.The primary endpoint was the incidence of major adverse cardiac events (MACE), which was defined as the composite of all-cause mortality, recurrent myocardial infarction, unplanned repeated revascularisation and cardiovascular death.
Twelve studies including a total of 7596 patients were identified. The MACE rate was 10.37% in early complete revascularisation compared with 18.17% in culprit only (p=0.01). When complete revascularisation was delayed, the MACE rate was 11.81% after complete revascularisation compared with 17.21% in culprit-only percutaneous coronary intervention (PCI) (p=0.01). A meta-regression analysis demonstrated no relationship between timing of complete revascularisation and reduction in MACE relative to culprit-only PCI (p=0.862).
In patients with STEMI treated by primary PCI and multivessel disease, there is a benefit of complete revascularisation over culprit-only PCI whether non-culprit revascularisation is performed early in hospital or delayed as an elective procedure. We have not demonstrated a relationship between timing of complete revascularisation and MACE.
CRD42021226789.
多项研究表明，完全血运重建可改善 ST 段抬高型心肌梗死（STEMI）和多支血管病变患者的临床结局。然而，非罪犯病变血运重建的最佳时机仍存在争议。
本系统评价和荟萃分析旨在评估 STEMI 合并多支血管病变患者完全血运重建时机对心血管结局的影响。
检索 2004 年至 2019 年期间的 PubMed、Cochrane 图书馆、ClinicalTrials.gov 和相关文献的参考文献列表。进行了配对分析，以比较 STEMI 患者早期完全血运重建（索引程序或索引住院期间）与延迟完全血运重建（出院后）之间临床结局的差异。主要终点是主要不良心脏事件（MACE）的发生率，定义为全因死亡率、复发性心肌梗死、非计划再次血运重建和心血管死亡的复合终点。
共纳入 12 项研究，总计 7596 例患者。早期完全血运重建的 MACE 发生率为 10.37%，而仅罪犯病变血运重建的发生率为 18.17%（p=0.01）。当延迟完全血运重建时，完全血运重建后 MACE 发生率为 11.81%，而仅罪犯病变经皮冠状动脉介入治疗（PCI）的发生率为 17.21%（p=0.01）。Meta 回归分析表明，完全血运重建时机与相对于仅罪犯病变 PCI 降低 MACE 之间无相关性（p=0.862）。
在接受直接经皮冠状动脉介入治疗和多支血管病变的 STEMI 患者中，与仅罪犯病变 PCI 相比，完全血运重建具有优势，无论非罪犯病变血运重建是在住院期间早期进行还是作为择期手术进行。我们尚未证明完全血运重建时机与 MACE 之间存在关系。
PROSPERO 注册号：CRD42021226789。
