Key result
Immediate complete revascularisation resulted in comparable 1-year mortality to staged revascularisation in randomized trials of patients with acute coronary syndrome and multivessel disease (OR 0.8).
Why the study?
Although revascularisation of non-culprit vessels is recommended in acute coronary syndrome with multivessel coronary artery disease, the optimal timing of complete revascularisation remains disputed.
Does immediate revascularisation of non-culprit arteries reduce 30-day and 1-year all-cause mortality in patients with acute coronary syndrome and multivessel coronary artery disease compared to staged revascularisation?
Meta-Analysis (n=10,737)
Does immediate revascularisation of non-culprit arteries reduce 30-day and 1-year all-cause mortality in patients with acute coronary syndrome and multivessel coronary artery disease compared to staged revascularisation?
Odds Ratio: 0.8 (95% CI 0.3–2.2)
Immediate and staged complete revascularisation of non-culprit arteries appear to have comparable mortality outcomes in ACS patients with multivessel disease when cardiogenic shock is excluded, though robust RCT data are currently lacking.
Supports either immediate or staged non-culprit revascularisation in ACS multivessel disease; extends pooled randomized evidence for equivalent 1-year mortality.
Although there is robust evidence that revascularisation of non-culprit vessels should be pursued in patients presenting with an acute coronary syndrome (ACS) and multivessel coronary artery disease (MVD), the optimal timing of complete revascularisation remains disputed. In this systematic review and meta-analysis our results suggest that outcomes are comparable for immediate and staged complete revascularisation in patients with ACS and MVD. However, evidence from randomised controlled trials remains scarce and cautious interpretation of these results is recommended. More non-biased evidence is necessary to aid future decision making on the optimal timing of complete revascularisation.
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Vriesendorp et al. (2022) conducted a meta-analysis in Acute coronary syndrome and multivessel coronary artery disease (n=10,737). Immediate complete revascularisation of non-culprit arteries vs. Staged complete revascularisation of non-culprit arteries was evaluated on 1-year all-cause mortality (RCTs) (OR 0.8, 95% CI 0.3-2.2). Immediate complete revascularisation resulted in comparable 1-year mortality to staged revascularisation in randomized trials of patients with acute coronary syndrome and multivessel disease (OR 0.8).
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