Meta-Analysis of Physiology-Guided Complete or Culprit Lesion-Only Percutaneous Coronary Interventions in Myocardial Infarction

Abstract

Whether physiology-guided complete revascularization of nonculprit lesions is superior to culprit lesion-only percutaneous coronary intervention (PCI) in patients with myocardial infarction (MI) and multivessel disease remains debated. Online databases were searched for randomized controlled trials comparing physiology-guided complete revascularization and culprit lesion-only PCI in patients with MI. The outcomes of interest were all-cause death, cardiovascular (CV) death, repeat revascularization, MI, stent thrombosis, and contrast-associated nephropathy/acute kidney injury. Pooled odds ratios, along with 95% confidence intervals (CI) were calculated. A total of 4,849 patients (n = 2,288 physiology-guided complete revascularization, n = 2,561 culprit lesion-only PCI) were included. The mean age was 66 years and 76% were men. At a mean follow-up of 2.5 years, physiology-guided complete revascularization was associated with significant reductions in CV death (odds ratio 0.72, 95% CI 0.54 to 0.97, p = 0.03) and repeat revascularizations (0.50, 95% CI 0.38 to 0.66, p <0.00001) compared with culprit lesion-only PCI. There were no differences between the 2 approaches in all-cause death (0.91, 95% CI 0.69 to 1.19, p = 0.50), MI (0.85, 95% CI 0.59 to 1.21, p = 0.36), stent thrombosis (1.24, 95% CI 0.58 to 2.69, p = 0.58), and contrast-associated nephropathy/acute kidney injury (1.07, 95% CI 0.88 to 1.31, p = 0.50). In conclusion, among patients with MI and multivessel disease, physiology-guided complete revascularization was associated with significant reductions in CV death and revascularizations compared with culprit lesion-only PCI.