Immediate Versus Staged Complete Revascularization for Patients With ST-Segment-Elevation Myocardial Infarction and...

Area of Science:

• Cardiology
• Interventional Cardiology
• Clinical Trials

Background:

• Outcomes of complete revascularization strategies for ST-elevation myocardial infarction (STEMI) with multivessel disease are not well-defined.
• Immediate, in-hospital staged, and out-of-hospital staged revascularization are potential approaches.

Purpose of the Study:

• To compare the clinical outcomes of immediate, in-hospital staged, and out-of-hospital staged complete revascularization in STEMI patients with multivessel disease.

Main Methods:

• A systematic review and meta-analysis of randomized controlled trials was conducted.
• Searched MEDLINE, SCOPUS, and Cochrane databases through August 2023.
• Included 9 trials with 4270 patients, focusing on major adverse cardiac events (MACEs).

Main Results:

• Immediate nonculprit PCI and staged nonculprit PCI (in-hospital) demonstrated similar MACE rates.
• Out-of-hospital staged nonculprit PCI was associated with significantly higher MACEs compared to immediate PCI.
• Staged out-of-hospital PCI also showed increased odds of ischemia-driven repeat revascularization.

Conclusions:

• Immediate nonculprit PCI is a safe and effective strategy for STEMI patients with multivessel disease.
• Staged in-hospital nonculprit PCI offers comparable outcomes to immediate PCI.
• Staged out-of-hospital nonculprit PCI should be approached with caution due to increased MACE risk.