Complete Revascularization Techniques for Acute Myocardial Infarction: A Systematic Review and Meta-Analysis Comparing Angiography- and Coronary Physiology-Guided PCI

Background: It is generally accepted that for patients with multivessel disease and myocardial infarction, complete revascularization is preferable than culprit-only revascularization. However, existing studies comparing coronary physiology-guided versus angiography-guided complete revascularization percutaneous coronary intervention (PCI) present conflicting conclusions.

Methods: The investigation involved a comprehensive search of PubMed/Medline, Embase, and the Cochrane library for studies comparing coronary physiology-guided with angiography-guided PCI in patients with MI-MVD. Clinical endpoints, including major adverse cardiovascular events, all-cause mortality, recurrent MI, major adverse cardiac and cerebral event, planned revascularization, repeated revascularization, average stent number per patient, heart failure, and contrast nephropathy during any follow-up period post PCI, were considered for analysis. Odds ratios (ORs) and mean differences with 95% confidence intervals (CIs) were calculated for binary and continuous variables, respectively. The analyses were conducted using Review Manager 5.1.

Results: Our analysis included a total of 2493 patients from 5 studies. The physiology-guided PCI group exhibited a lower rate of planned revascularization (OR: 0.10, 95% CIs: 0.07–0.14, p ≤ 0.001, and I² = 96.6%) and average stent number per patient (mean difference: −0.47, 95% CIs: −0.56–−0.38, p ≤ 0.001, and I² = 58.6%). However, there were no significant differences between the two groups regarding major adverse cardiac event (MACE) (OR: 0.89, 95% CIs: 0.63–1.26, p = 0.520, and I² = 67.8%), all-cause mortality (OR: 0.65, 95% CIs: 0.38–1.12, p = 0.120, and I² = 50.5%), recurrent MI (OR: 0.74, 95% CIs: 0.28–2.00, p = 0.558, and I² = 77.2%), major adverse cardiac and cerebral event (MACCE) (OR = 0.77, 95% CIs: 0.43–1.37, p = 0.378, and I² = 0%), repeated revascularization (OR = 1.47, 95% CIs: 0.54–3.99, p = 0.452, and I² = 76.5%), heart failure (OR: 1.04, 95% CIs: 0.43–2.56, p = 0.924, and I² = 0%), and contrast nephropathy (OR: 1.26, 95% CIs: 0.27–5.81, p = 0.766, and I² = 0%).

Conclusions: Among patients with MI-MVD, physiology-guided PCI appeared to reduce the need for planned revascularization without triggering repeated revascularization, leading to fewer stents compared with angiography-guided PCI. Other prespecified clinical outcomes including MACE, all-cause mortality, recurrent MI, MACCE, heart failure, and contrast nephropathy were not significantly different between these two approaches.