ORIGINAL ARTICLE - CLINICAL SCIENCE
Complete Revascularization (CR) Versus Culprit-Only Percutaneous Coronary Intervention (CO-PCI) in NSTE-ACS with Multivessel Disease: A Systematic Review and Meta-Analysis
Kesar Prajapati,
Shanmukh Sai Pavan Lingamsetty,
Harshith Thyagaturu,
Phillip Englund,
Vijaykumar Sekar,
Dipesh Ludhwani,
Vikrant Jagadeesan,
Kesar Prajapati
Internal Medicine, Metropolitan Hospital Center, NYC Health + Hospital, New York, New York, USA
Search for more papers by this authorShanmukh Sai Pavan Lingamsetty
Mamata Medical College, Khammam, India
Search for more papers by this authorHarshith Thyagaturu
Department of Cardiology, West Virginia University Heart and Vascular Institute, Morgantown, West Virginia, USA
Search for more papers by this authorPhillip Englund
West Virginia School of Medicine, Morgantown, West Virginia, USA
Search for more papers by this authorVijaykumar Sekar
Department of Medicine, Lehigh Valley Health Network, Allentown, Pennsylvania, USA
Search for more papers by this authorDipesh Ludhwani
Department of Cardiology, University of Maryland Shore Regional Health, Maryland, USA
Search for more papers by this authorCorresponding Author
Vikrant Jagadeesan
Department of Cardiology, West Virginia University Heart and Vascular Institute, Morgantown, West Virginia, USA
Correspondence: Vikrant Jagadeesan ([email protected])
Search for more papers by this authorKesar Prajapati,
Shanmukh Sai Pavan Lingamsetty,
Harshith Thyagaturu,
Phillip Englund,
Vijaykumar Sekar,
Dipesh Ludhwani,
Vikrant Jagadeesan,
Kesar Prajapati
Internal Medicine, Metropolitan Hospital Center, NYC Health + Hospital, New York, New York, USA
Search for more papers by this authorShanmukh Sai Pavan Lingamsetty
Mamata Medical College, Khammam, India
Search for more papers by this authorHarshith Thyagaturu
Department of Cardiology, West Virginia University Heart and Vascular Institute, Morgantown, West Virginia, USA
Search for more papers by this authorPhillip Englund
West Virginia School of Medicine, Morgantown, West Virginia, USA
Search for more papers by this authorVijaykumar Sekar
Department of Medicine, Lehigh Valley Health Network, Allentown, Pennsylvania, USA
Search for more papers by this authorDipesh Ludhwani
Department of Cardiology, University of Maryland Shore Regional Health, Maryland, USA
Search for more papers by this authorCorresponding Author
Vikrant Jagadeesan
Department of Cardiology, West Virginia University Heart and Vascular Institute, Morgantown, West Virginia, USA
Correspondence: Vikrant Jagadeesan ([email protected])
Search for more papers by this authorFirst published: 28 April 2025
ABSTRACT
Objective
Contemporary data have demonstrated that a complete revascularization (CR) strategy reduces adverse cardiovascular events compared with culprit vessel only-Percutaneous Coronary Intervention (CO-PCI) in ST Elevation Myocardial Infarction (STEMI). The optimal strategy of CR versus CO-PCI in Non-ST-Elevation Acute Coronary Syndrome (NSTE-ACS) remains unclear and was the goal of this meta-analysis.
Methods
A systematic search of PubMed, Embase, and Cochrane databases for English-language studies from inception till November 2024 comparing CR versus CO-PCI in NSTE-ACS patients with multi-vessel disease was performed. A meta-analysis was performed using a random-effects model to calculate the risk ratio (RR) and 95% confidence interval (CI). Primary outcomes were all-cause mortality and myocardial reinfarction.
Results
Eleven studies with total 36,997 NSTE-ACS patients were included in study with mean follow up of 31.3 months. CR showed reduction in all-cause mortality (1,457 of 16,939) compared to CO-PCI (2126 of 16,939) (RR: 0.66; 95% CI: 0.55 to 0.79). Myocardial reinfarction occurred in 149 of 6404 in CR versus 248 of 6404 in CO-PCI group (RR:0.57; 95% CI: 0.43 to 0.76). Composite endpoint was noted in 299 of 2,129 patients from CR vs 418 of 2131 patients from CO- PCI (RR:0.72; 95% CI: 0.63 to 0.82). Repeat revascularization was noted in 504 of 5661 patients from CR versus 849 of 5663 in CO- PCI patients group (RR:0.60; 95% CI: 0.54 to 0.66).
Conclusion
In NSTEMI and multivessel disease, CR reduces all-cause mortality, recurrent myocardial infarction, composite outcome, and repeat revascularization compared to CO-PCI.
Conflicts of Interest
The authors declare no conflicts of interest.
Open Research
Data Availability Statement
The data that supports the findings of this study are available in the Supporting Information S1: Material of this article.
Supporting Information
| Filename | Description |
|---|---|
| ccd31558-sup-0001-Supplementary_Appendix_upd_3_0.docx7.7 MB | Supplementary Appendix upd 3. |
Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
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