Physiology-Versus Angiography-Guided Complete Coronary Revascularization in STEMI Patients with Multivessel Disease: A Network Meta-Analysis


Di Mario et al., 2004 [13]NRCulprit vessel along with, as minimum, one significant stenosis in a major non-culprit coronary vessel.Angio-guided CR vs. culprit-onlyAll-cause death, recurrent myocardial infarction, and repeat revascularizationTwelvePoliti et al., 2010 [14]2003–07Stenosis greater than 70% in, at minimum, two epicardial coronary arteries or their major branches.Angio-guided CR vs. culprit-onlyAll-cause death, recurrent myocardial infarction, hospitalization for ACS, and revascularizationThirtyGhani et al., 2012 [15]2004–07Stenosis greater than 50% in, at minimum, two epicardial coronary arteries, or the combination of a side branch and a major coronary vessel supplying distinct myocardial territories.Physio-guided CR vs. culprit-onlyFFR < 0.75 (for stenosis between 50% and 90%) or stenosis greater than 90%.All-cause death, recurrent myocardial infarction, and urgent revascularizationThirty-sixWald et al., 2013 [16]2008–13Stenosis greater than 50% in, at minimum, one epicardial coronary artery excluding the culprit vessel.Angio-guided CR vs. culprit-onlyCV mortality, recurrent myocardial infarction, and refractory angina.Twenty-threeEngstrøm, et al., 2015 [17]2011–14Stenosis greater than 50% in, at minimum, one epicardial coronary artery excluding the culprit vessel.Physio-guided CR vs. culprit-onlyFFR ≤ 0.80 (for stenosis between 50% and 90%) or stenosis greater than 90%.All-cause death, recurrent myocardial infarction, and IDR.Twenty-sevenGershlick et al., 2015 [18]2011–13Culprit vessel along with, at minimum, one lesion in a major non-culprit coronary artery (stenosis greater than 70% in single view or greater than 50% in two views).Angio-guided CR vs. culprit-onlyAll-cause death, recurrent myocardial infarction, hospital admission for heart failure,
and repeat revascularization.TwelveHamza et al., 2016 [19]2013–14Stenosis greater than 80% in, at minimum, one epicardial coronary artery excluding the culprit vessel.Angio-guided CR vs. culprit-onlyAll-cause death, recurrent myocardial infarction, and IDR.SixOmar et al., 2017 [20]2009–11Stenosis greater than 70% in, at minimum, one epicardial coronary artery excluding the culprit vessel.Angio-guided CR vs. culprit-onlySixSmits et al., 2017 [9]2011–15Stenosis greater than 50% in, at minimum, one epicardial coronary artery excluding the culprit vessel.Physio-guided CR vs. culprit-onlyFFR ≤ 0.80
(for stenosis between 50% and 69%)All-cause death, nonfatal myocardial infarction, any revascularization, and
cerebrovascular eventsTwelveMehta et al., 2019 [8]2013–17The presence in, at minimum, one angiographically significant non-culprit stenosis, suitable for successful PCI, located in a vessel with minimum diameter of 2.5 mm, and not treated during the index PCI procedure.Angio-guided CR vs. culprit-onlyFFR ≤ 0.80 (for stenosis between 50% and 69%) or stenosis greater than 70%.CV death, myocardial infarction, or IDR.Thirty-sixPuymirat et al., 2021 [10]2016–18Stenosis greater than 50% in, at minimum, one epicardial coronary artery excluding the culprit vessel.Physio-guided CR vs. angio-guided CRFFR ≤ 0.80 (for stenosis greater than 50%)All-cause mortality, nonfatal MI, and unplanned hospitalization leading to urgent revascularization.Thirty-sixJoo Myung Lee et al., 2023 [11]2016–20Diameter stenosis greater than 50% in, at minimum, one coronary artery excluding the culprit vessel, in a major epicardial artery, or side branch with a minimum diameter of 2.0 mm, judged eligible for PCI.Physio-guided CR vs. angio-guided CRFFR ≤ 0.80 (for stenosis greater than 50%)Death, myocardial infarction, or repeat revascularizationForty-twoBiscaglia et al., 2023 [21]2019–21The presence of at least one lesion in a non-culprit vessel with a visual estimated diameter stenosis between 50% and 99%, in a vessel with a minimum diameter of 2.5 mm.Physio-guided CR vs. culprit-onlyFFR ≤ 0.80, QFR ≤ 0.80, iFR ≤ 0.89Death, myocardial infarction, stroke, or any repeat revascularization at 1 year.TwelveBohm et al., 2024 [22]2016–19Presence of at least one stenosis in a non-culprit artery with a visual estimated diameter stenosis between 50% and 99%, in a vessel with a minimum diameter of 2.5 mm.Physio-guided CR vs. culprit-onlyFFR ≤ 0.80 (FFR was suggested but not mandatory for stenosis between 90% and 99%)Death from any cause, new myocardial infarction, and unplanned revascularization.Fifty-eight



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