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Immediate versus staged complete revascularization in patients with acute coronary syndrome and multivessel disease:

Lin He1, Qing-Juan Yang1, Bin Sun1

  • 1Department of Cardiology, Beijing Anzhen Nanchong Hospital of Capital Medical University and Nanchong Central Hospital (The Second Clinical College of North Sichuan Medical College), Nanchong, Sichuan, China.

Frontiers in Cardiovascular Medicine
|October 15, 2025
PubMed

Insights

Immediate complete revascularization for acute coronary syndrome (ACS) patients with multivessel disease significantly reduces major adverse cardiovascular events (MACE) and repeat myocardial infarction compared to staged procedures. This approach is safe, not increasing all-cause mortality.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Clinical Trials

Background:

  • Complete revascularization is superior to culprit-only revascularization in acute coronary syndrome (ACS) with multivessel disease.
  • The optimal timing for complete revascularization (immediate vs. staged) in ACS patients remains a critical clinical question.
  • This study addresses the safety and efficacy of immediate versus staged complete revascularization strategies.

Purpose of the Study:

  • To compare the efficacy and safety of immediate versus staged complete revascularization in patients with ACS.
  • To evaluate the impact on major adverse cardiovascular events (MACE) and other key clinical outcomes.
  • To provide evidence-based guidance on the optimal timing of revascularization in this patient population.

Main Methods:

  • Meta-analysis of 11 randomized controlled trials involving 5,666 patients.
  • Primary outcome: Major Adverse Cardiovascular Events (MACE).
  • Statistical analysis included Mantel-Haenszel fixed-effect model and trial sequential analysis for result validation.

Main Results:

  • Immediate complete revascularization significantly reduced MACE (RR: 0.76, P=0.0004) compared to staged procedures.
  • Significant reductions observed in repeat myocardial infarction (RR: 0.59, P=0.002) and repeat revascularization (RR: 0.62, P<0.0001).
  • No significant difference in all-cause or cardiovascular mortality between the groups.

Conclusions:

  • Immediate complete revascularization is associated with significantly lower MACE, repeat myocardial infarction, and repeat revascularization in ACS patients with multivessel disease.
  • The immediate strategy does not increase the risk of all-cause mortality.
  • Findings support the consideration of immediate complete revascularization for selected ACS patients.
Abstract

Keywords:
acute coronary syndromeimmediate complete revascularizationmultivessel disease (MVD)percutaneous coronary interventionstaged complete revascularization

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