| references |
publication date |
design and intervention |
number of patients and randomisation |
inclusion criteria |
exclusion criteria |
delay of revascularization |
primary (1) and secondary (2) endpoints |
main results |
Dambrink et al.
[5] |
2010 |
Culprit PPCI + medical treatment (conservative group) vs culprit PPCI + FFR in vessels with a significant stenosis
(PCI performed if FFR < 0.75 or directly for severe lesions >90%) (invasive group) |
121 patients :
- 80 patients in invasive group
- 41 patients in conservative group |
STEMI with >50% stenosis in ≥ 2 arteries |
- > 80 years
- CTO of non IRA
- Prior CABG
- Left main significant stenosis
- In-stent restenosis
- Chronic AF |
Invasive group : during index hospitalization or electively during the 3 weeks following (mean 7.5 days (5-20)) |
1) LVEF at 6 months
2) MACE at 6 months |
1) No LVEF difference : 59+/-9% in invasive group and 57+/-9% in conservative group : p=0.362
2) No difference in MACE : 21% in invasive group and 22% in conservative group : p=0.929 |
Di Mario et al.
[6] |
2004 |
Culprit PPCI with additional revascularization at the investigators discretion (need and timing decided according to clinical status, evidence of ischemia in non-invasive tests or angiographic severity) vs complete revascularization during index catheterization
Study using only one or more heparin coated stents (HepaCoat stents) |
69 patients :
- 17 patients in culprit lesion treatment only group
- 52 patients in complete revascularization group |
STEMI < 12h with MVD with 1-3 lesions in non IRA |
- Lesion in vein and arterial grafts
- In-stent restenosis
- Chronic Total Occlusion
- Thrombolysis
- Cardiogenic shock
- Left main significant stenosis |
Not specified for culprit lesion treatment only group |
1) 12-month incidence of any repeat revascularization
2) (a) Composite with in hospital repeat revascularization, reinfarction and death
(b) total 12-month cost |
1) No significant difference in the incidence of new revascularization at 12 months : 35.3% in the culprit treatment group vs 17.3% in complete revascularization group, p = 0.174)
2) (a) Similar incidence of in-hospital MACE in the 2 groups : 0 and 3.8% in culprit and multivessel treatment, p=0.164)
(b)No difference in total cost at 12-months : Euro 22,330 +/- Euro 13,653 in culprit treatment group vs Euro 20,382 +/- Euro 11,671 in complete revascularization group, p = 0.323). |
Politi et al.
[7] |
2010 |
3 strategies
- Culprit PPCI only
- Full revascularization during index catheterization
- Full revascularization during staged procedure |
214 patients :
- 84 patients in the culprit PPCI only group,
- 65 patients in the complete revascularization group
- 65 patients in the staged revascularization group |
STEMI < 12h with > 70% stenosis in ≥ 2 arteries |
- Cardiogenic shock
- Left main significant stenosis
- Previous CABG
- Severe valvular disease
- Unsuccessful procedure |
56.9 ± 12.9 days after the primary PCI for the staged revascularization group |
1) MACE at 2.5 years
2) (a) Each event of MACE assessed individually
(b) Survival free of MACE
(c) Survival
(d) Multivariate analyses |
1) MACE occurred in 42 patients (50%) in the culprit only revascularization group, in 13 patients (20%) in the staged revascularization group and in 15 patients (23.1%) in the complete revascularization group (p<0.001).
2) (a) The incidence of inhospital death, repeat revascularization and re-hospitalization was significantly
higher in the culprit only revascularization group (all p<0.05). No significant difference in re-infarction among the three groups.
(b) Survival free of MACE was worse in the culprit only revascularization group compared with both the complete revascularization group (p=0.002) and the staged revascularization group (p=0.001),
No difference between the complete and staged revascularization groups (p=0.815).
(c) Tendency for a worse overall survival in the culprit only revascularization group compared with the other two groups (p=0.151). |
| Wald et al. [4] |
2013 |
Complete revascularization vs culprit PPCI + subsequent PCI only for refractory angina with objective evidence of ischemia |
465 patients :
- 234 patients in preventive PCI group (complete revascularization)
- 231 patients in no preventive PCI group (culprit PPCI only) |
STEMI < 12h with
Stenosis ≥
50% in one or more coronary arteries other than the IRA and cardiologist consider that both infarct artery-only PCI and preventive PCI would be acceptable
treatment options. |
- Cardiogenic
shock
- Previous CABG
- Left main stenosis > 50%
- Chronic Total Occlusion |
Number and timing of requiring subsequent PCI in no preventive PCI group were not specified |
1) composite endpoint of cardiac death, non fatal myocardial infarction and refractory angina at 36 months
2) (a)Each item of composite endpoint assessed individually
(b) Non cardiac death
(c) Repeat revascularization |
Trial prematurely stopped
1) Significant reduction of composite endpoint in preventive PCI group with 21 patients (9%) vs 53 patients (22.9%) in no preventive PCI group (p<0.001)
2) (a) No difference for death from cardiac causes : 4 patients in preventive PCI group and 10 in no preventive PCI group (p=0.07) but significant reduction for myocardial infarction (7 vs 20 patients, p=0;009) and refractory angina (12 vs 30 patients, p=0.002) respectively in preventive PCI group and no preventive PCI group
(b) No difference between the 2 groups for non cardiac death (p=0.86)
(c) Significant reduction of repeat revascularization in preventive PCI group (p<0.001) |
