Revascularization Strategies for Multivessel Disease in Acute Coronary Syndrome: Network Meta-analysis

Area of Science:

• Cardiology
• Interventional Cardiology
• Cardiovascular Medicine

Background:

• The optimal revascularization strategy for patients with acute coronary syndrome (ACS) and multivessel disease (MVD) is a subject of ongoing debate.
• This study aims to compare the efficacy and safety of different revascularization approaches in this patient population.

Purpose of the Study:

• To compare the effectiveness and safety of complete index procedure (CIP) and complete staged procedure (CSP) against culprit-only (CO) revascularization in patients with ACS and MVD.
• To evaluate outcomes including mortality, myocardial infarction, need for revascularization, and safety events.

Main Methods:

• A systematic review and meta-analysis of 20 studies comparing CIP, CSP, and CO revascularization strategies.
• Outcomes assessed included all-cause mortality, cardiac death, recurrent myocardial infarction (MI), need for revascularization, bleeding, contrast-induced nephropathy (CIN), stroke, and stent thrombosis.

Main Results:

• Both CIP and CSP significantly reduced the need for revascularization compared to CO (CIP: RR 0.42; CSP: RR 0.53).
• CSP was associated with lower cardiac death (RR 0.67), while CIP showed fewer recurrent MIs (RR 0.58).
• No significant differences were observed in all-cause mortality, bleeding, CIN, stroke, or stent thrombosis among the strategies.

Conclusions:

• Complete revascularization (CIP or CSP) is recommended over CO for patients with ACS and MVD due to reduced need for future procedures.
• CSP demonstrated a benefit in reducing cardiac deaths, and CIP in reducing recurrent MIs.
• Both complete revascularization strategies were found to be safe, with no increased risk of adverse events compared to CO.