Key result
Immediate revascularization yields no mortality benefit vs staged procedures but reduces MI ~43% and TVR.
Why the study?
Guidelines recommend revascularization of non-culprit lesions following primary PCI for ACS with multivessel disease, but the optimal timing remains uncertain.
Does immediate revascularization of non-culprit lesions reduce 1-year all-cause mortality compared to staged revascularization in patients with acute coronary syndrome and multivessel coronary artery disease undergoing primary PCI?
Meta-Analysis (n=3,886)
Does immediate revascularization of non-culprit lesions reduce 1-year all-cause mortality compared to staged revascularization in patients with acute coronary syndrome and multivessel coronary artery disease undergoing primary PCI?
Immediate revascularization of non-culprit lesions in ACS patients with multivessel disease reduces the risk of target vessel revascularization and myocardial infarction at 1 year compared to staged procedures, without affecting all-cause mortality.
Supports immediate non-culprit PCI to lower TVR and MI in multivessel ACS; extends meta-analytic evidence favoring complete revascularization without mortality reduction.
BACKGROUND: Recent guidelines for acute coronary syndrome (ACS) with multivessel coronary artery disease (MVD) recommend revascularization of non-culprit lesions following primary percutaneous coronary intervention (PCI). However, the optimal timing for this procedure-whether immediate or staged-remains uncertain. METHODS: A comprehensive search using PubMed (MEDLINE), Cochrane Central, and Google Scholar was conducted to identify studies comparing clinical outcomes between immediate and staged revascularization approaches in patients with MVD undergoing PCI. A random effects model was used to calculate risk ratios (RRs) for dichotomous outcomes with 95% confidence intervals (CIs). The primary outcome was 1-year all-cause mortality. RESULTS: A total of 10 randomized controlled trials (RCTs), comprising 3886 patients (1964 in the immediate revascularization group and 1940 in the staged revascularization group), with a median follow-up of 12 months, were included in the analysis. No significant difference in the risk of 1-year mortality was noted between the two approaches. The risk of target vessel revascularization (TVR) at 1-year follow-up was significantly lower in the immediate revascularization group compared to the staged revascularization group (RR: 0.64; 95% CI: 0.47-0.86; I²: 0%; p = 0.03). Additionally, the immediate revascularization group had a significantly lower risk of myocardial infarction (MI) at 1-year follow-up than the staged approach (RR: 0.57; 95% CI: 0.37-0.88; I²: 10%; p = 0.01). CONCLUSION: This meta-analysis suggests that immediate revascularization is associated with a significantly lower risk of TVR and MI at 1-year compared to staged revascularization.
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Yasmin et al. (2025) conducted a meta-analysis in Acute Coronary Syndrome with multivessel coronary artery disease (n=3,886). Immediate revascularization vs. Staged revascularization was evaluated on 1-year all-cause mortality. Immediate revascularization yielded no difference in 1-year mortality but reduced target vessel revascularization (RR 0.64; 95% CI 0.47-0.86) and MI (RR 0.57) compared to staged procedures.
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