Meta-Analysis Comparing Immediate Versus Staged Complete Revascularization for ST-Elevation Myocardial Infarction...

Area of Science:

• Cardiology
• Interventional Cardiology
• Clinical Trials

Background:

• ST-segment elevation myocardial infarction (STEMI) patients often have multivessel coronary artery disease (CAD).
• The optimal timing for complete revascularization (CR) in these patients is not well-established.
• Immediate versus staged CR strategies are debated for STEMI with multivessel CAD.

Purpose of the Study:

• To compare major adverse cardiovascular events (MACEs) and procedural complications between immediate and staged CR in STEMI patients with multivessel CAD.
• To systematically review and meta-analyze randomized controlled trials (RCTs) addressing this clinical question.
• To provide evidence-based insights into the optimal revascularization strategy for STEMI and multivessel CAD.

Main Methods:

• Systematic review and meta-analysis of RCTs.
• Searched MEDLINE, Embase, and Cochrane Libraries up to March 6, 2024.
• Included 5 RCTs with 1,415 patients, analyzed using RevMan software.

Main Results:

• No significant differences in MACEs (13.3% vs 9.8%), all-cause mortality (3% vs 4.55%), or myocardial infarction (4.5% vs 2.6%) between immediate and staged CR at 16-month follow-up.
• Staged CR was associated with a higher rate of unplanned revascularization (8.6% vs 4.4%).

Conclusions:

• Immediate versus staged CR shows similar MACE rates in STEMI patients with multivessel CAD at approximately 1.3-year follow-up.
• Staged revascularization leads to a higher incidence of unplanned, ischemia-driven revascularization.
• Staged revascularization within the index hospitalization may be effective, but further trials are needed.