Complete revascularization after MI reduces mortality, cardiac events

Patients who undergo complete revascularization with percutaneous coronary intervention following a myocardial infarction (MI) are at lower risk of all-cause mortality, cardiovascular mortality, MI, major adverse cardiac events (MACE), and repeat revascularization, reports a recent study.

“There may be benefits to immediate complete revascularization, but additional head-to-head trials are needed,” the investigators said.

This systematic review with frequentist and Bayesian network meta-analyses included the totality of randomized data investigating revascularization strategies in patients presenting with MI and multivessel coronary artery disease.

The investigators compared complete (immediate or staged) versus culprit revascularization and assessed the timing and methods of achieving complete revascularization. All-cause mortality was the primary outcome. Twenty-four trials involving 16,371 patients (mean follow-up 26.4 months) met the eligibility criteria.

All-cause mortality decreased in patients with any MI who underwent complete revascularization as opposed to culprit revascularization (relative risk [RR], 0.85, 95 percent confidence interval [CI], 0.74‒0.99; p=0.04), as did cardiovascular mortality, MI, MACE, and repeat revascularization.

In patients with ST-segment elevation MI, all-cause mortality was also reduced with complete revascularization (RR, 0.91, 95 percent CI, 0.78‒1.05; p=0.18). Similar rates of stent thrombosis, major bleeding and acute kidney injury were observed between the two procedures.

“Immediate complete revascularization ranked higher than staged complete revascularization for all endpoints,” the investigators said.