Comparison of immediate and staged complete revascularization in patients with acute coronary syndrome and multivessel coronary disease: a systematic review and meta-analysis

BMC Cardiovasc Disord. 2024 Dec 20;24(1):724. doi: 10.1186/s12872-024-04414-9.

Abstract

Background: The optimal timing of complete revascularization (CR) in patients with acute coronary syndrome (ACS) and multivessel disease (MVD) is still debated. The safety and efficacy of immediate and staged CR (ICR vs. SCR) in this patient group were thus compared.

Methods and results: PubMed, Embase, and CENTRAL were systematically searched to identify randomized controlled trials of CR strategies for MVD. Studies comparing cardiovascular benefits between ICR and SCR in ACS patients with MVD were included. Short- and long-term outcomes were compared using random-effect risk ratios (RRs). The analysis included seven studies with 3445 patients. The ICR and SCR groups showed comparable risks of all-cause death at 1 year (RR: 1.18; 95% CI: 0.72 to 1.95), but the risk increased at 1 month in ICR patients (RR: 2.35; 95% CI: 1.12 to 4.91). ICR reduced the risk of myocardial infarction (MI, RR: 0.54; 95% CI: 0.33 to 0.90) and target vessel revascularization (TVR, RR: 0.62; 95% CI: 0.45 to 0.85) at 1 year.

Conclusion: The all-cause death rates were comparable between ICR and SCR strategies. CR at index procedure could reduce MI and TVR rates at 1 year (46% and 38%, respectively). Future studies need to obtain more precise evidence and identify the cardiovascular benefits of these two strategies.

Clinical trial number: Not applicable.

Keywords: Acute coronary syndrome; Immediate complete revascularization; Multivessel disease; Percutaneous coronary intervention; Staged complete revascularization.

Publication types

  • Systematic Review
  • Meta-Analysis

MeSH terms

  • Acute Coronary Syndrome* / diagnosis
  • Acute Coronary Syndrome* / diagnostic imaging
  • Acute Coronary Syndrome* / mortality
  • Acute Coronary Syndrome* / surgery
  • Acute Coronary Syndrome* / therapy
  • Aged
  • Coronary Artery Disease* / diagnostic imaging
  • Coronary Artery Disease* / mortality
  • Coronary Artery Disease* / surgery
  • Coronary Artery Disease* / therapy
  • Female
  • Humans
  • Male
  • Middle Aged
  • Myocardial Revascularization / adverse effects
  • Myocardial Revascularization / mortality
  • Percutaneous Coronary Intervention / adverse effects
  • Percutaneous Coronary Intervention / mortality
  • Risk Assessment
  • Risk Factors
  • Time Factors
  • Time-to-Treatment
  • Treatment Outcome