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Immediate versus staged revascularization in acute coronary syndrome and multivessel disease: a meta-analysis and

Felix Bergmann1, Anselm Jorda1, Theresa Pecho1

  • 1Department of Clinical Pharmacology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.

Internal and Emergency Medicine
|May 12, 2026
PubMed

Insights

For acute coronary syndrome (ACS) patients with multivessel disease, immediate revascularization showed similar 1-year mortality compared to staged procedures. Further research is needed to clarify potential benefits or harms of immediate intervention.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Clinical Trials

Background:

  • Optimal management for non-culprit lesions in acute coronary syndrome (ACS) with multivessel disease remains debated.
  • Immediate versus staged revascularization strategies require comparative analysis.

Purpose of the Study:

  • To compare the efficacy of immediate versus staged revascularization strategies in patients with ACS and multivessel disease.
  • To evaluate all-cause mortality and cardiovascular events at one year post-intervention.

Main Methods:

  • A meta-analysis of randomized controlled trials (RCTs) was conducted.
  • Data from ten RCTs involving 5651 patients were analyzed.
  • Primary outcome: all-cause mortality at 1 year. Secondary outcomes: cardiovascular events at 1 year.

Main Results:

  • No significant difference in 1-year all-cause mortality (3.9% vs. 3.5%) or cardiovascular death (2.8% vs. 2.4%) between immediate and staged revascularization groups.
  • Meta-regression indicated higher mean patient age was associated with a trend favoring immediate revascularization.
  • Effect estimates do not rule out clinically meaningful benefits or harms of immediate revascularization.

Conclusions:

  • Immediate and staged revascularization strategies yield similar 1-year mortality and cardiovascular event rates in ACS patients with multivessel disease.
  • The findings suggest current evidence does not definitively favor one strategy over the other.
  • Further investigation is warranted to elucidate potential differential effects based on patient characteristics.

Keywords:
ACSAngiographyAngioplastyInterventionMyocardial infarctionPCI

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