Meta-analysis of Physiology-guided Complete or Culprit lesion-only Percutaneous Coronary Interventions in Myocardial Infarction.

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