ObjectiveCompare the therapeutic effects of multivessel percutaneous coronary intervention (MV-PCI) and culprit-only revascularization strategy (C-PCI) in percutaneous coronary intervention (PCI) for patients with acute myocardial infarction complicated by cardiogenic shock (AMICS) and multivessel disease (MVD). MethodsThe PubMed, Embase, Cochrane Library, MEDLINE, Web of Science, CENTRAL, CNKI and WanFang Data databases were searched to collect studies comparing C-PCI vs. MV-PCI in patients with AMI and CS from inception to March 2, 2025. Methodological quality of the included studies was assessed using the Newcastle-Ottawa scale (NOS) and the risk of bias (ROB) tool. Meta-analysis was performed using RevMan software (version 5.4.0). ResultsA total of 18 studies (1 randomized controlled trial, 1 post-hoc analysis of a randomized controlled trial, and 16 retrospective observational studies), enrolling 101 693 patients. The results of the observational studies showed that MV-PCI was associated with higher risk of short-term mortality (OR=1.13, 95%CI 1.01 to 1.25, P=0.03), renal replacement therapy (OR=1.41, 95%CI 1.32 to 1.50, P<0.00001), and cerebrovascular accident events (OR=1.21, 95%CI 1.10 to 1.33, P=0.0001). No significant difference was observed in long-term mortality (OR=0.93, 95%CI 0.74 to 1.16, P=0.51), recurrent myocardial infarction (OR=1.16, 95%CI 0.97 to 1.39, P=0.10), repeat revascularization events (OR=0.83, 95%CI 0.58 to 1.20, P=0.33) and bleeding event rates (OR=1.01, 95%CI 0.71 to 1.34, P=0.97) between groups. The results remained consistent after adding the only randomized trial.ConclusionsIn patients with AMICS and concomitant MVD, C-PCI provides comparable survival benefits to MV-PCI and is associated with a reduced risk of all-cause mortality, cerebrovascular events, and the need for renal replacement therapy.
Objective To compare postoperative survival rates and the incidence of adverse events in patients with three-vessel disease undergoing complete versus incomplete revascularization during coronary artery bypass grafting (CABG). Methods A retrospective analysis was conducted on patient data from Tianjin Chest Hospital who underwent primary isolated CABG surgery between 2019 and 2020. Patients were divided into a complete revascularization group and an incomplete revascularization group based on the revascularization status after surgery. Inverse probability of treatment weighting (IPTW) was used for risk adjustment. Results A total of 1 419 patients were included in the study, with 1 086 (76.5%) undergoing complete revascularization. IPTW analysis showed that complete revascularization could reduce the incidence of major adverse cardiovascular and cerebrovascular events (MACCE) [HR=0.596, 95%CI (0.404, 0.880), P=0.010] and angina [HR=0.560, 95%CI (0.377, 0.823), P=0.004]. Conclusion In patients with multivessel coronary artery disease, complete revascularization may be associated with improved patient outcomes.
