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Comparison of Immediate Versus Staged Complete Revascularization in Patients With Index PCI Coronary Complications: A

Alessandro Gabrielli1, Jacob J Elscot1, William Camilleri1

  • 1Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands.

Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions
|July 24, 2026
PubMed

Insights

Immediate complete revascularization (ICR) is safe for acute coronary syndrome patients with unresolved complications, showing similar outcomes to staged complete revascularization (SCR). Complex lesion morphology and STEMI presentation predict complications.

Area of Science:

  • Cardiology
  • Interventional Cardiology

Background:

  • Complete revascularization (CR) improves outcomes in acute coronary syndrome (ACS) with multivessel disease (MVD) over culprit-only percutaneous coronary intervention (PCI).
  • The optimal timing for CR, immediate (ICR) versus staged (SCR), remains under investigation, particularly concerning unresolved procedural complications.

Purpose of the Study:

  • To assess if unresolved culprit-lesion complications impact outcomes of ICR versus SCR.
  • To identify predictors of procedural complications in patients undergoing PCI for ACS with MVD.

Main Methods:

  • Post hoc analysis of the BIOVASC trial involving 1487 patients.
  • Classification and assessment of culprit-lesion-related complications and their resolution status.
  • Evaluation of 2-year clinical outcomes (MACE) based on randomized ICR vs. SCR strategy and logistic regression for complication predictors.

Main Results:

  • 10.3% of procedures had culprit-lesion complications, with 81.7% unresolved post-PCI.
  • Patients with unresolved complications showed similar 2-year MACE rates between ICR (10.6%) and SCR (17.2%).
  • Complex culprit lesion morphology (B2/C) and STEMI presentation were independent predictors of procedural complications.

Conclusions:

  • Immediate complete revascularization (ICR) demonstrates comparable 2-year outcomes to staged complete revascularization (SCR) in patients with unresolved culprit lesion complications.
  • Complex lesion morphology and STEMI presentation are significant predictors of procedural complications.
  • ICR is a safe and viable strategy for hemodynamically stable patients, even with procedural challenges during PCI.
Abstract

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