Meta-analysis To Compare Effects Of The Different Strategy Of Complete Revascularization To Hemodynamically Stable STEMI Patients With Multivessel Coronary Artery Disease On Prognosis

Backgroud:Acute ST-segment elevation myocardial infarction(STEMI)is associated with the highest risk of shock and death in coronary heart disease.Approximately 50% of STEMI patients have multiple coronary artery lesions,that is,severe stenosis of non-infarct related arteries(n IRA)in addition to the infarct related arteries(IRA).PCI is the main treatment for coronary heart disease,especially STEMI.In the treatment of STEMI complicated with multi-vessel coronary artery disease,the treatment strategy of PCI has been widely concerned and discussed.Evidence has shown that complete revascularization,which means revascularization of both infarct related and non-infarct related arteries,has a better prognosis in PCI of hemodynamically stable STEMI patients with multi-vessel coronary disease than criminal vessel revascularization alone.For hemodynamically unstable STEMI patients with multi-vessel coronary disease,the current evidence does not recommend simultaneous revascularization of both convict and non-convict vessels.However,for hemodynamically stable STEMI patients with multi-vessel coronary disease,the optimal timing of complete revascularization is still unclear.Whether to perform revascularization intantly(IR)or in stages after the criminal vessel revascularization(SR)remains controversial.Objective:To compare the effect of staging(SR)or immediate(IR)complete revascularization on medium-and-long-term outcomes in hemodynamically stable STEMI patients with multi-vessel coronary disease.Result:After screening and evaluating 2446 results,11 studies were finally included in our meta-analysis.Pooled analysis showed that: In the pooled results of the RCT study,although there was no statistically significant difference in the effect of SR and IR on the risk of all-cause and cardiovascular death in patients with STEMI with multi-vessel coronary disease,the SR strategy was still showed a trend of lower risk of all-cause death(RR 0.87,95%CI 0.39-1.92;P =0.727)and cardiovascular death(RR 0.60,95%CI 0.29-1.26;P =0.178).The pooled results of the n RCT study showed that SR significantly reduced the risk of all-cause mortality in STEMI patients with multi-vessel coronary disease(RR 0.50,95%CI 0.31-0.78;P = 0.003)relative to IR.SR patients did not have a statistically significant advantage in the risk of cardiovascular death,but there was a trend toward a relative benefit(RR 0.60,95%CI 0.29-1.26;P =0.178).In both RCT and n RCT studies,the risk of re-myocardial infarction and target vessel revascularization was similar in patients whether receiving SR or IR strategies.In the subgroup analysis,SR significantly reduced the risk of all-cause death compare to IR in patients who completed early stage revascularization(RR 0.45,95%CI0.34-0.60;p<0.001),without left main artery disease(RR 0.49,95%CI 0.26-0.92;p=0.027),and had relatively mild stenosis(RR 0.47,95%CI 0.35-0.64;p<0.001).Conclusion:For patients with hemodynamically stable STEMI complicated with MVD,the staging complete revascularization(SR)strategy may have a lower risk of medium-and long-term all-cause mortality,so it can be actively considered to perform relatively early staging complete revascularization in clinical practice,especially in patients without LMCAD and with relatively mild n IRA stenosis.