The quality of evidence is downgraded by study limitations (unclear allocation concealment), and by imprecise results (few outcome events).
A Cochrane review [Abstract] 1 included 9 studies with a total of 2 633 subjects with ST-elevation myocardial infarction (STEMI) and multi-vessel coronary disease. A complete revascularization was compared with culprit-only revascularization strategy. Six studies performed the intervention on the non-culprit vessels as a staged intervention, and 3 studies performed the intervention of the non-culprit vessels at the same index procedure. Six studies were performed in Europe, 1 in China, and 2 studies did not report where the study was carried out. The majority of participants were men; male percentage per group was between 61% and 89%.
The complete and the culprit-only revascularization strategies did not differ for long-term all-cause mortality. The complete revascularization strategy was associated with a lower proportion of long-term cardiovascular mortality, long-term non-fatal myocardial infarction, and long-term revascularization. There was no diffference in combined adverse events. Trial Sequential Analysis of long-term all-cause mortality, long-term cardiovascular mortality, and long-term non-fatal myocardial infarction showed that more studies are needed to reach more conclusive results on these outcomes, but more studies may not change present results for long-term repeat revascularization.
| Outcome | Relative effect (95% CI) | Risk with culprit only | Risk with complete revascularization | Participants (studies) |
|---|---|---|---|---|
| Long-term all-cause mortality (≥ 1 year after the intervention) | RR 0.80(0.58 to 1.11) | 63 per 1000 | 50 per 1000(37 to 70) | 2 417(8 studies) |
| Long-term cardiovascular mortality (≥ 1 year after the intervention) | RR 0.50(0.32 to 0.79) | 47 per 1000 | 23 per 1000(15 to 37) | 2 229(6 studies) |
| Long-term myocardial infarction (≥ 1 year after the intervention) | RR 0.62(0.44 to 0.89) | 70 per 1000 | 43 per 1000(31 to 62) | 2 099(6 studies) |
| Long-term revascularization (≥ 1 year after the intervention) | RR 0.47(0.39 to 0.57) | 208 per 1000 | 98 per 1000(81 to 118) | 2 616(9 studies) |
| Overall adverse events (pooled short and long term) | OR 0.84(0.58 to 1.21) | 29 per 1000 | 24 per 1000(17 to 35) | 4 086(6 studies) |
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