Immediate versus staged complete revascularization for patients with ST-segment-elevation myocardial infarction and multivessel disease: A meta-analysis

Background The comparative outcomes of immediate versus staged complete revascularization (CR) in patients with ST-segment–elevation myocardial infarction (STEMI) and multivessel disease remain unclear. Methods We searched the PubMed, Web of Science, EMBASE and Cochrane Library databases until December 11, 2025. The primary endpoints included a composite outcome, all-cause mortality and recurrent MI. We expressed continuous outcome data as mean differences (MDs) and dichotomous outcome data as risk ratios (RRs). Results Eight randomized controlled trials involving 4133 patients were included. Pooled results showed that no significant difference was detected between immediate versus staged CR on the composite outcome (RR,0.91; 95% CI,0.67–1.23;), all-cause mortality (RR,1.33; 95% CI,0.99–1.79) and recurrence MI (RR,0.74; 95% CI,0.50–1.10). ICR did not confer significant differences for individual secondary outcomes (cardiac-cause mortality, repeat revascularization, hospitalization for heart failure, and major bleeding) compared with staged PCI. Additionally, subgroup analyses suggested that treatment effects may vary according to the deferral interval and drug-eluting stent (DES) generation. Conclusions In patients with STEMI and multivessel disease, immediate and staged CR were associated with comparable clinical outcomes. However, the timing of staged PCI and DES generation may influence outcomes.