Revascularización de lesión no culpable en pacientes con infarto agudo de miocardio. Revisión sistemática y metaanálisis

Introduction: Multivessel disease is present in approximately 50% of patients experiencing acute myocardial infarction. Initially, revascularization of the culprit lesion during primary PCI was exclusively recommended for patients in cardiogenic shock. Objective: The aim of this study was to assess whether complete revascularization is associated with reduced cardiovascular mortality and adverse cardiovascular events. Material and Methods: A search was conducted in the following bibliographic databases: MEDLINE, Cochrane, Embase, ISI Web of Science, and CENTRAL (Cochrane Central Register of Controlled Trials), SciELO. The search was performed in February 2024, without a time limit, and was updated monthly until June 2024. Randomized controlled trials or meta-analyses of randomized controlled trials were selected, with no restrictions on publication year or language that included the following terms: myocardial revascularization, ST-segment elevation myocardial infarction, coronary artery disease, and coronary stenosis. Results: The systematic review and meta-analysis included seven randomized controlled trials involving 6597 patients, comparing complete revascularization with culprit-only percutaneous coronary intervention. The complete revascularization strategy was associated with a significantly lower risk of major adverse cardiovascular events (RR= 0.50, 95% CI: 0.56-0.74; p<0.001, I2= 0%) and repeated revascularizations (RR=0.32, 95% CI: 0.24-0.42; p<0.001, I2= 42%). Conclusions: Our findings demonstrate that revascularization of non-culprit lesions in patients with STEMI is associated with a significant reduction in major adverse cardiovascular events, repeated revascularizations, and the composite outcome of cardiac death and non-fatal myocardial infarction.