Key result
Immediate revascularization cuts unplanned repeat procedures ~40% vs. staged PCI with comparable MACE.
Why the study?
Recent trials suggested potential superiority of immediate versus staged complete revascularization in STEMI with multivessel disease, but undetected procedural MI may have influenced findings, and prior meta-analyses included observational studies without BioVasc STEMI data.
Does immediate complete revascularization reduce major adverse cardiovascular events compared to staged complete revascularization in patients presenting with STEMI and multivessel disease?
Meta-Analysis (n=2,023)
Yes
Does immediate complete revascularization reduce major adverse cardiovascular events compared to staged complete revascularization in patients presenting with STEMI and multivessel disease?
Relative Risk: 0.86 (95% CI 0.58–1.27)
Absolute Event Rate: 8.9% vs 11.8%
p-value: p=0.45
Immediate complete revascularization for STEMI patients with multivessel disease offers comparable safety regarding hard clinical outcomes compared to staged procedures, while significantly reducing the need for unplanned revascularization.
Supports immediate complete revascularization in STEMI with multivessel disease given comparable MACE; extends RCT evidence by reducing unplanned revascularization.
Background: Recent randomized clinical trials (RCTs) of STEMI patients with multi-vessel disease (MVD) reported potential superiority of immediate (ICR) vs. staged complete revascularization (SCR). Inherently, the risk of procedural MI is less likely to be detected in ICR patients, and this may have influenced the results. Recently published meta-analyses encompassed observational studies without including STEMI data from the BioVasc trial. The aim of this meta-analysis was to perform an updated comparison of the two strategies in STEMI patients with MVD. Methods: Electronic databases were searched from their inception till August 2024 to identify RCTs assessing CR timing in STEMI patients with MVD. Only studies with an endpoint involving major adverse cardiovascular events (MACE) were included. Results: Six RCTs totaling 2023 patients were included in the analysis. The median time to staged PCI was 19 days. The incidence of MACE (as defined by each study’s protocol) was comparable between the two strategies [RR 0.86, 95% CI (0.58 to 1.27)]. There was also no difference in the risk of non-procedural MI [RR 0.91, 95% CI (0.49–1.67)], death [RR 1.47, 95% CI (0.89–2.44)] and cardiovascular death [RR 1.53, 95% CI (0.79–2.98)]. There was a significant 40% reduction in unplanned revascularization in patients undergoing ICR versus SCR [RR 0.60 (0.40 to 0.89), p = 0.01]. Conclusions: ICR reduced the risk of unplanned revascularization compared to SCR but had a comparable effect on MACE, death, cardiovascular death and non-procedural MI. Both strategies are safe in managing patients with acute MI and MVD.
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Kuzemczak et al. (2024) conducted a meta-analysis in ST-Elevation Myocardial Infarction with Multivessel Disease (n=2,023). Immediate complete revascularization vs. Staged complete revascularization was evaluated on Major adverse cardiovascular events (MACE) (RR 0.86, 95% CI 0.58-1.27, p=0.45). Immediate complete revascularization resulted in comparable rates of MACE compared to staged complete revascularization (RR 0.86, p=0.45), but significantly reduced unplanned revascularization by 40%.
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