Immediate Versus Staged Complete Revascularization in Patients Presenting with Acute Myocardial Infarction and...

Current guidelines recommend complete revascularization for patients with multivessel disease (MVD) presenting with acute myocardial infarction (AMI); however, the optimal timing of complete revascularization remains debated. We aimed to compare the outcomes of immediate versus staged complete revascularization in this population. Following PRISMA and Cochrane methodological standards, we systematically searched electronic databases from inception to March 2026 to identify randomized controlled trials (RCTs) comparing immediate versus staged complete revascularization in AMI patients with MVD. The primary outcomes were major adverse cardiac events (MACE) and all-cause mortality, assessed using reconstructed individual patient data (IPD) derived from published Kaplan-Meier curves. Secondary outcomes included cardiovascular disease (CVD) mortality and unplanned repeat revascularization. Hazard ratios (HRs) were pooled using random-effects Cox regression models. Thirteen RCTs including 8,247 patients (3,855 [46.7%] immediate complete revascularization; 4,392 [53.3%] staged complete revascularization) were analyzed. There were no significant differences between strategies in the risks of MACE (HR, 0.88; 95% CI, 0.76-1.01; p = 0.08), all-cause mortality (HR, 1.30; 95% CI, 0.91-1.86; p = 0.10), or CVD mortality (HR, 1.64; 95% CI, 0.96-2.78; p = 0.07). Immediate complete revascularization complete revascularization was associated with a significantly lower 4-year risk of unplanned repeat revascularization (HR, 0.44; 95% CI, 0.30-0.64; p < 0.001). In patients with AMI and multivessel disease, immediate and staged complete revascularization yielded similar overall estimates for MACE and mortality, although clinically meaningful differences, particularly for mortality, cannot be excluded. Immediate complete revascularization significantly reduced the risk of repeat revascularization.