Summary of findings for the main comparison. Complete revascularisation compared to culprit‐only revascularisation in ST elevated myocardial infarction with multi‐vessel disease.
| Complete revascularisation compared to culprit‐only revascularisation in ST elevated myocardial infarction with multi‐vessel disease | ||||||
| Patient or population: people with STEMI and MVD. Intervention: complete revascularisation. Comparison: culprit only. | ||||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect (95% CI) | No of participants (studies) | Quality of the evidence (GRADE) | Comments | |
| Risk with culprit only | Risk with complete revascularisation | |||||
| Long‐term all‐cause mortality (≥ 1 year after the intervention) | Study population | RR 0.80 (0.58 to 1.11) | 2417 (8 RCTs) | ⊕⊝⊝⊝ Very low 1,2,3,4 | PRAMI study terminated early. CvLPRIT and PRAMI concerning for attrition bias. Only CvLPRIT was judged to have low risk for selection bias. | |
| 63 per 1000 | 50 per 1000 (37 to 70) | |||||
| Long‐term cardiovascular mortality (≥ 1 year after the intervention) | Study population | RR 0.50 (0.32 to 0.79) | 2229 (6 RCTs) | ⊕⊝⊝⊝ Very low 1,2,3,4 | PRAMI study terminated early. CvLPRIT and PRAMI concerning for attrition bias. Only CvLPRIT was judged to have low risk for selection bias. | |
| 47 per 1000 | 23 per 1000 (15 to 37) | |||||
| Long‐term myocardial infarction (≥ 1 year after the intervention) | Study population | RR 0.62 (0.44 to 0.89) | 2099 (6 RCTs) | ⊕⊝⊝⊝ Very low 1,2,3,4 | PRAMI study terminated early. CvLPRIT and PRAMI concerning for attrition bias. Only CvLPRIT was judged to have low risk for selection bias. | |
| 70 per 1000 | 43 per 1000 (31 to 62) | |||||
| Overall adverse events (pooled short and long term) | Study population | OR 0.84 (0.58 to 1.21) | 4086 (6 RCTs) | ⊕⊝⊝⊝ Very low 1,2,3,4 | PRAMI study terminated early. CvLPRIT and PRAMI concerning for attrition bias. Only CvLPRIT was judged to have low risk for selection bias. Open label to the operator may affect this outcome. | |
| 29 per 1000 | 24 per 1000 (17 to 35) | |||||
| Short‐term all‐cause mortality (within the first 30 days after the intervention) | Study population | RR 0.65 (0.18 to 2.37) | 696 (2 RCTs) | ⊕⊝⊝⊝ Very low 1,2,3,4 | HELP‐AMI trial did not describe in detail their methodology to analyse for bias. | |
| 15 per 1000 | 10 per 1000 (3 to 36) | |||||
| Long‐term revascularisation (≥ 1 year after the intervention) | Study population | RR 0.47 (0.39 to 0.57) | 2616 (9 RCTs) | ⊕⊝⊝⊝ Very low 1,2,3 | PRAMI study terminated early. CvLPRIT and PRAMI concerning for attrition bias. Only CvLPRIT was judged to have low risk for selection bias. Open label to the operator may affect this outcome. | |
| 208 per 1000 | 98 per 1000 (81 to 118) | |||||
| *The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; MVD: multi‐vessel disease; RCT: randomised controlled trial; RR: risk ratio; STEMI: ST elevated myocardial infarction. | ||||||
| GRADE Working Group grades of evidence High quality: We are very confident that the true effect lies close to that of the estimate of the effect. Moderate quality: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. Low quality: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect. Very low quality: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect. | ||||||
1 Downgraded due to publication (reporting) bias.
2 Downgraded due to study limitations (largely risk of attrition bias and selection bias).
3 Downgraded because of indirectness: black and Hispanic people, as well as women were under‐represented.
4 Downgraded due to imprecision.