Single Versus Multiple Vessel Stenting In Patients With St-Elevation Myocardial Infarction: Results From A 30,886-Patient Meta-Analysis Giuseppe Biondi Zoccai, University of Turin, Turin, Italy (gbiondizoccai@gmail.com) Marzia Lotrionte, Catholic University, Rome, Italy Claudio Moretti, University of Turin, Turin, Italy Filippo Sciuto, University of Turin, Turin, Italy Pierluigi Omedè, University of Turin, Turin, Italy Antonio Abbate, VCU Pauley Heart Center, Richmond, Va Pierfrancesco Agostoni, University Medical Center Utrecht, Utrecht, The Netherlands Giuseppe Sangiorgi, University of Modena, Modena, Italy Imad Sheiban, University of Turin, Turin, Italy

Background and Aim There is uncertainty on the most appropriate management of patients with acute ST- elevation myocardial infarction (STEMI) and concomitant multivessel coronary artery disease. We thus performed a systematic review and meta-analysis comparing a culprit-only vs. multivessel percutaneous coronary intervention (PCI) in this setting.

Methods Pertinent controlled clinical studies including 30 or more patients and comparing a culprit-only vs. multivessel PCI strategy in patients with STEMI were systematically searched in several databases. The primary end-point was the rate of major adverse cardiac events (MACE, i.e. the composite of death, recurrent myocardial infarction, or repeat revascularization). Secondary end-points included individual components of MACEs. Risk differences (RD, with 95% confidence intervals) were computed using random-effect methods.

Results (1) From a total of 687 citations, 10 clinical trials were shortlisted (with only 1 randomized study), including 30,886 patients with STEMI and concomitant multivessel disease, treated with a culprit-only vs. multivessel PCI, and followed for a median of 12 months after discharge. Meta-analytic pooling showed similar 12-month rates of MACEs (RD=-3% [-9%; +3%], p=0.33), death (RD=-1% [-3%; +1%], p=0.23), recurrent myocardial infarction (RD=-2% [-8%; +3%], p=0.40,) or repeat revascularization (RD=0% [- 6%; 5%], p=0.88).

Results (2) After an average follow-up of 24±15 months, unadjusted rates of MACE were 17.7% vs. 16.4%, with death in 2.7% vs 4.9%, myocardial infarction in 4.4% vs. 3.7%, TLR in 15.0% vs. 12.3%, and stent thrombosis in 3.1% vs. 2.7% (all p>0.05). Even at extensive multivariable analysis with propensity adjustment, IVUS guidance was not associated with any statistically significant impact on the risk of MACE, death, myocardial infarction, TLR (neither on the main branch nor on the side branch), or stent thrombosis (all p>0.05).

Risk of major adverse cardiac events

Risk of death

Risk of myocardial infarction

Risk of repeat revascularization

Conclusions Despite the fact that multivessel coronary disease detrimentally impacts on the prognosis of STEMI patients, a culprit-only revascularization strategy should be sought after in most cases, unless patient instability or symptoms/signs of residual myocardial ischemia clearly support non-culprit vessel intervention.

Thank you for your attention For any correspondence: gbiondizoccai@gmail.com For these and further slides on these topics feel free to visit the metcardio.org website: http://www.metcardio.org/slides.html