Timing of Complete Revascularization in Patients With STEMI and Multivessel Disease: An Updated Meta-Analysis of Randomized Clinical Trials

Mohammed A Elbahloul; Shrouk Ramadan; Eman E Labeeb; Shahed Aldalahmeh; Ahella Ismail A Mousa; Ahmed Elazab; Ahmed N Mohamed; Ahmad Elashery; Mehiar O El-Hamdani; Carl J Lavie; Gregg W Stone

doi:10.1161/CIRCINTERVENTIONS.126.016601

Timing of Complete Revascularization in Patients With STEMI and Multivessel Disease: An Updated Meta-Analysis of Randomized Clinical Trials

Circ Cardiovasc Interv. 2026 Apr 30:e016601. doi: 10.1161/CIRCINTERVENTIONS.126.016601. Online ahead of print.

Authors

Affiliations

¹ Faculty of Medicine, Kafr El-Shaikh University, Egypt (M.A.E.).
² Faculty of Medicine, Ain Shams University, Cairo, Egypt (S.R.).
³ Faculty of Medicine, Al-Azhar University, Cairo, Egypt (E.E.L.).
⁴ Faculty of Medicine, Jordan University of Science and Technology, Al Ramtha, Jordan (S.A.).
⁵ Faculty of Pharmacy, Badr University in Cairo (BUC), Egypt (A.I.A.M.).
⁶ Faculty of Medicine, South Valley University, Qena, Egypt (A. Elazab).
⁷ Department of Internal Medicine, Charleston Area Medical Center (CAMC), WV. (A.N.M.).
⁸ Cardiology Department, Charleston Area Medical Center (CAMC), WV. (A. Elashery).
⁹ Joan C Edwards School of Medicine - Marshall University, Huntington, WV (M.O.E.-H.).
¹⁰ Ochsner Clinical School, John Ochsner Heart and Vascular Institute, The University of Queensland School of Medicine, New Orleans, LA (C.J.L.).
¹¹ Icahn School of Medicine at Mount Sinai, New York, NY (G.W.S.).

PMID: 42059073
DOI: 10.1161/CIRCINTERVENTIONS.126.016601

Abstract

Background: The ideal timing for complete revascularization (CR) in patients with ST-segment-elevation myocardial infarction and multivessel disease is uncertain. This meta-analysis examined outcomes of immediate CR (ICR) versus staged CR (SCR).

Methods: Four databases were searched for randomized controlled trials that compared ICR and SCR in ST-segment-elevation myocardial infarction and multivessel disease. The primary end points of interest were short-term and long-term all-cause mortality. Outcomes are presented as risk ratios for short-term outcomes and incidence rate ratios for long-term outcomes with 95% CIs.

Results: The analysis included 9 randomized controlled trials in which 4213 patients were enrolled. Short-term all-cause mortality occurred in 2.0% of patients after ICR compared with 1.2% of patients after SCR (risk ratio, 1.66 [95% CI, 0.99-2.78], P=0.053; I²=0%). Short-term cardiac death was increased after ICR (risk ratio, 2.19 [95% CI, 1.08-4.44], P=0.03; I²=0%). At a median 1-year follow-up, all-cause mortality occurred in 4.7% of patients after ICR compared with 3.5% of patients after SCR (incidence rate ratio, 1.40 [95% CI, 0.97-2.03], P=0.07; I²=0%). No significant differences were identified between the ICR and SCR strategies at either short-term or long-term follow-up for other outcomes, including myocardial infarction, repeat revascularization, stent thrombosis, stroke, major bleeding, and the composite of major adverse cardiac or cerebrovascular events.

Conclusions: In hemodynamically stable patients with ST-segment-elevation myocardial infarction and multivessel disease, an ICR strategy may increase short-term cardiac death compared with SCR, and the possibility of increased early and late all-cause mortality cannot be excluded. Despite some uncertainty, these results currently favor a staged CR strategy for most patients with ST-segment-elevation myocardial infarction and multivessel disease.

Registration: URL: https://www.crd.york.ac.uk/PROSPERO/; Unique identifier: CRD420251163719.

Keywords: death; humans; incidence; stents; stroke.