Journal of the American College of Cardiology (JACC)Percutaneous Coronary Revascularization Strategies After MI

Complete Revascularization vs. Culprit-Only Strategy in Myocardial Infarction: Implications for Patient Outcomes

A comprehensive network meta-analysis of 24 randomized trials has provided new insights into revascularization strategies for patients with myocardial infarction (MI) and multivessel coronary artery disease. The study, published in the Journal of the American College of Cardiology, compared complete revascularization to culprit-only revascularization, offering important findings for clinical practice.

Study Design:

• 24 eligible trials included
• 16,371 patients randomized
• Weighted mean follow-up: 26.4 months
• Primary outcome: All-cause mortality
• Secondary outcomes: Cardiovascular mortality, MI, major adverse cardiac events (MACE), and repeat revascularization

Key Findings:

• Complete revascularization reduced all-cause mortality by 15% compared to culprit-only revascularization (RR, 0.85; 95% CI, 0.74-0.99; p = 0.04)
• Significant reductions observed in cardiovascular mortality, MI, MACE, and repeat revascularization with complete revascularization
• In ST-segment elevation MI patients, all-cause mortality with complete revascularization showed a trend towards reduction (RR, 0.91; 95% CI, 0.78-1.05; p = 0.18)
• No significant differences in stent thrombosis, major bleeding, or acute kidney injury between strategies
• Immediate complete revascularization ranked higher than staged complete revascularization for all endpoints

HCN Medical Memo
ALthough this network meta-analysis provides compelling evidence for the benefits of complete revascularization in MI patients with multivessel disease, it’s important to note the inherent limitations of such analyses. Clinicians should consider these findings in the context of individual patient characteristics and risk factors. Further randomized controlled trials are needed to definitively establish the optimal timing (immediate vs. staged) and guidance method (physiology-guided vs. angiography-guided) for complete revascularization.

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