Staged Versus Immediate Complete Revascularization in Patients With STEMI and Multivessel Disease: An Updated...

Area of Science:

• Cardiology
• Interventional Cardiology
• Clinical Trials

Background:

• Complete revascularization is key for ST-elevation myocardial infarction (STEMI) with multivessel coronary artery disease (MVD).
• The optimal timing for intervening on non-infarct arteries—immediate revascularization (IR) versus staged revascularization (SR)—remains unclear.

Purpose of the Study:

• To systematically review and meta-analyze randomized controlled trials comparing SR and IR in STEMI patients with MVD.
• To evaluate the impact of revascularization timing on major adverse cardiovascular events and other safety and mortality outcomes.

Main Methods:

• Systematic review and meta-analysis of 8 randomized controlled trials involving 5077 patients (2556 SR, 2521 IR).
• Random-effects models with Hartung-Knapp adjustment were used.
• Trial sequential analysis and Grading of Recommendations Assessment, Development, and Evaluation (GRADE) were employed to assess evidence conclusiveness and certainty.

Main Results:

• No significant differences were found between SR and IR for major adverse cardiovascular events (OR, 1.07; 95% CI, 0.76-1.49).
• Comparable rates were observed for recurrent myocardial infarction, cardiovascular mortality, all-cause mortality, stent thrombosis, stroke, unplanned revascularization, major bleeding, acute kidney injury, and heart failure hospitalization.
• Trial sequential analysis indicated insufficient information size, and the certainty of evidence was low to very low.

Conclusions:

• Staged and immediate complete revascularization yield comparable ischemic, safety, and mortality outcomes in STEMI patients with MVD.
• Current evidence suggests clinical equipoise regarding revascularization timing.
• Individualized treatment decisions are recommended pending results from larger, adequately powered trials.