STEMI Case Study

ST- Elevation MI comprises approximately 25-40 % of MI presentation and approximately 50 % of STEMI patients have significant stenosis of other non-culprit arteries as a part of a multi vessel occlusion disease which confer a substantially increased risk of cardiovascular morbidity and mortality. According to ACC/AHA guidelines for the management of STEMI 2013, primary PCI for the culprit artery is the recommended method of revascularization in STEMI. PCI should not be performed in a non-culprit artery at the time of primary PCI in patients with STEMI who are hemo-dynamically stable ( class III (level B)). PCI in a non-culprit artery is only indicated at a time separate from primary PCI(delayed) in patients who have spontaneous symptoms of
myocardial ischemia.(Hong, 2012; Levine et al., 2016; O'Gara et al., 2013)
However, some recent trials demonstrated better outcome of complete revascularization more than revascularization of culprit only in selected portions of patients which .
Still , there are conflicting results in randomized controlled trials (RCTs) comparing culprit artery only PCI with multi-vessel PCI either at the same sitting of the primary PCI or as a staged procedure, likely because of differing inclusion criteria , statistical heterogeneity, sample size and variable endpoints.("," ; "," ; Engstrøm et al., 2015; Politi et al., 2010)
Therefore, we performed a systematic review of randomized controlled trials and meta-analyses to compare the effectiveness between culprit-only PCI to multi-vessel PCI in patients with STEMI and multi-vessel disease and between the two types of complete revascularization namely immediate and staged PCI. Also , to assess the adverse effects as major adverse cardiac events ,mortality ,re-infarction ,repeat revascularization ,bleeding and kidney dysfunction
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Engstrøm, T., Kelbæk, H., Helqvist, S., Høfsten, D. E., Kløvgaard, L., Holmvang, L., . . . Køber, L. (2015). Complete revascularisation versus treatment of the culprit lesion only in patients with ST-segment elevation myocardial infarction and multivessel disease (DANAMI-3—PRIMULTI): an open-label, randomised controlled trial. The Lancet, 386(9994), 665-671. doi: 10.1016/s0140-6736(15)60648-1
Hong, M. K. (2012). Recent Advances in the Treatment of ST-Segment Elevation Myocardial Infarction. Scientifica (Cairo), 2012, 683683. doi: 10.6064/2012/683683
Levine, G.
N., Bates, E. R., Blankenship, J. C., Bailey, S. R., Bittl, J. A., Cercek, B., . . . Zhao, D. X. (2016). 2015 ACC/AHA/SCAI Focused Update on Primary Percutaneous Coronary Intervention for Patients With ST-Elevation Myocardial Infarction: An Update of the 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention and the 2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction. J Am Coll Cardiol, 67(10), 1235-1250. doi: 10.1016/j.jacc.2015.10.005
O'Gara, P. T., Kushner, F. G., Ascheim, D. D., Casey, D. E., Jr., Chung, M. K., de Lemos, J. A., . . . American College of Cardiology Foundation/American Heart Association Task Force on Practice, G. (2013). 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation, 127(4), e362-425. doi: 10.1161/CIR.0b013e3182742cf6
Politi, L., Sgura, F., Rossi, R., Monopoli, D., Guerri, E., Leuzzi, C., . . . Modena, M. G. (2010). A randomised trial of target-vessel versus multi-vessel revascularisation in ST-elevation myocardial infarction: major adverse cardiac events during long-term follow-up. Heart, 96(9), 662-667. doi:
10.1136/hrt.2009.177162