SynthesisClinical cardiology2014
Culprit vessel only vs immediate complete revascularization in patients with acute ST-segment elevation myocardial infarction: systematic review and meta-analysis.
Synthesis in Clinical cardiology, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers, 2 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
6 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Optimal Timing of Complete Revascularization in Acute Coronary Syndrome: A Systematic Review and Meta-Analysis.Journal of the American Heart Association · 2017Pooled it
- Impact of Incomplete Percutaneous Revascularization in Patients With Multivessel Coronary Artery Disease: A Systematic Review and Meta-Analysis.Journal of the American Heart Association · 2016Pooled it
- Complete Revascularization Versus Treatment of the Culprit Artery Only in ST Elevation Myocardial Infarction: A Multicenter Registry.Arquivos brasileiros de cardiologia · 2020Article
- Reperfusion strategies in acute myocardial infarction and multivessel disease.Nature reviews. Cardiology · 2017Review
- Revascularization Strategies in STEMI with Multivessel Disease: Deciding on Culprit Versus Complete-Ad Hoc or Staged.Current cardiology reports · 2017Review
- Complete Treatment Versus Residual Lesion - Long-Term Evolution After Acute Coronary Syndrome.Arquivos brasileiros de cardiologia · 2016Observational
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
4 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Although multivessel coronary artery disease has been associated with poor health outcomes in patients with acute ST-segment elevation myocardial infarction (STEMI), the optimal approach to revascularization remains uncertain. The objective of this review was to determine the benefits and harms of culprit vessel only vs immediate complete percutaneous coronary intervention (PCI) in patients with acute STEMI. We searched MEDLINE, EMBASE, the Cochrane Register of Controlled Trials, and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) for randomized controlled trials (RCTs). Teams of 2 reviewers, independently and in duplicate, screened titles and abstracts, completed full-text reviews, and abstracted data. We calculated pooled risk ratios (RRs) and associated 95% confidence intervals (CIs) using random-effect models for nonfatal myocardial infarction (MI), revascularization, cardiovascular mortality, all-cause mortality, and adverse events, and used the GRADE approach to rate confidence in estimates of effect. Of 341 patients randomized to complete revascularization and followed to study conclusion, 31 experienced revascularization, as did 80 of 324 randomized to culprit vessel only revascularization (RR: 0.35, 95% CI: 0.24-0.53). Ten patients in the complete revascularization group and 28 patients in the culprit vessel only revascularization group experienced nonfatal MI (RR: 0.35, 95% CI: 0.17-0.72). All-cause mortality and cardiac deaths did not differ between groups (RR: 0.69, 95% CI: 0.40-1.21 for all-cause mortality; RR: 0.48, 95% CI: 0.22-1.04 for cardiac deaths). Pooled data from 3 RCTs suggest that immediate complete revascularization probably reduces revascularization in patients with acute STEMI; although results suggest possible benefits on MI and death, confidence in estimates is low.
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