A comparison of multivessel and culprit vessel percutaneous coronary intervention in non-ST-segment elevation acute coronary syndrome patients with multivessel disease: a meta-analysis

Aims: Percutaneous revascularisation triage has not been evaluated in randomised controlled trials of patients with non-ST-segment elevation acute coronary syndromes (NSTE-ACS) and multivessel disease. As a result, current guidelines are not available. The objective of our meta-analysis was to investigate the use of percutaneous coronary intervention (PCI) in culprit and non-culprit vessels. Methods and results: We undertook a meta-analysis of controlled studies where patients were assigned to multivessel PCI or culprit vessel PCI. Summary odds ratios (OR) for all-cause mortality, myocardial infarction, unplanned revascularisation and major adverse cardiac events (MACE) were calculated using randomor fixed-effect models. Six registry studies (n=5,414) were included in this meta-analysis. There was no difference in the rate of mortality (OR, 0.85; 95% CI: 0.70 to 1.04; p=0.114) or myocardial infarction (OR, 0.75; 95% CI: 0.43 to 1.32; p=0.319) between the two treatment groups. Multivessel PCI may decrease long-term MACE (OR, 0.69; 95% CI: 0.51 to 0.93; p=0.015) and unplanned revascularisation (OR, 0.64; 95% CI: 0.45 to 93; p=0.018) compared with culprit vessel PCI. Conclusions: No significant difference was demonstrated in the long-term risk of myocardial infarction and mortality between multivessel PCI and culprit vessel PCI. Therefore, multivessel PCI may be a safe and reasonable option for NSTE-ACS patients with multivessel disease.