Meta-Analysis Compares Immediate Versus Staged Revascularization in Heart Attack Patients

A meta-analysis of randomized controlled trials evaluating patients with ST-segment elevation myocardial infarction and multivessel coronary artery disease found no significant difference in major adverse cardiovascular events between immediate complete revascularization and staged complete revascularization. The investigation evaluated whether non-culprit lesions should be treated during the primary intervention or managed across separate scheduled procedures, addressing an ongoing clinical question regarding the optimal timing of full arterial treatment.

Multivessel coronary artery disease occurs frequently among individuals experiencing ST-segment elevation myocardial infarction, presenting clinicians with critical timing decisions regarding the treatment of secondary arterial narrowings. Although opening the primary culprit lesion is the established emergency procedure, determining the most effective window for complete revascularization has continued to generate debate. The research team specifically designed the systematic evaluation to analyze clinical endpoints and determine how immediate and staged approaches perform across pooled randomized trial populations.

The study protocol established major adverse cardiovascular events as the primary clinical outcome of interest. To capture a thorough profile of clinical safety and effectiveness, researchers tracked secondary clinical endpoints including all-cause death, cardiac death, recurrent myocardial infarction, and unplanned revascularization across the participating trial cohorts. These parameters allowed the investigators to contrast both acute ischemic recurrences and procedure-related mortality between the two procedural timing strategies.

The quantitative synthesis encompassed seven randomized controlled trials comprising a total cohort of 3,017 patients, who were monitored across a mean follow-up period of 1.06 years. The study populations demonstrated wide demographic variation, with cohort mean ages ranging from 58.6 to 66.0 years. Male participants constituted between 62.3 percent and 83.0 percent of the individual trial groups, reflecting typical acute coronary intervention demographics.

Underlying cardiovascular risk profiles varied notably among the pooled study cohorts, reflecting distinct clinical baselines across the seven constituent randomized trials. Preexisting diabetes mellitus prevalence ranged from 13.8 percent to 42.0 percent among the evaluated study participants, while hypertension was documented in 40.0 percent to 94.0 percent of patients. These baseline factors defined the clinical complexity of the overall patient sample analyzed in the pooled dataset.

Analysis of the primary endpoint revealed that major adverse cardiovascular events developed in 10.3 percent of patients in the immediate complete revascularization group compared with 11.4 percent in the staged complete revascularization group. The relative difference yielded a risk ratio of 0.96 with a 95 percent confidence interval spanning from 0.67 to 1.37, which did not reach statistical significance at a p-value of 0.81. Similarly, secondary analyses revealed no statistically significant differences between the two treatment arms regarding cardiac death or unplanned revascularization.

Significant divergences emerged, however, when examining all-cause mortality and recurrent myocardial infarction between the intervention strategies. Immediate complete revascularization demonstrated a higher rate of all-cause mortality at 5.0 percent compared with 3.4 percent among staged revascularization recipients, producing a risk ratio of 1.45 with a 95 percent confidence interval of 1.02 to 2.05 and a p-value of 0.04. Conversely, staged revascularization exhibited a higher incidence of myocardial infarction at 4.4 percent versus 2.8 percent in the immediate revascularization arm, generating a risk ratio of 0.64 with a 95 percent confidence interval of 0.41 to 0.99 and a p-value of 0.04.

The study authors noted that the conflicting divergence among secondary endpoints warrants cautious interpretation despite the similarity in overall major adverse cardiovascular event rates. Because immediate intervention correlated with increased all-cause mortality while staged intervention carried an elevated risk of subsequent myocardial infarction, the investigators concluded that staged complete revascularization may help clinicians balance ischemic risk reduction against procedural safety in selected patients presenting with ST-segment elevation myocardial infarction and multivessel coronary artery disease.

Subject of Research: Timing of complete revascularization in ST-segment elevation myocardial infarction with multivessel coronary artery disease

Article Title: Timing of revascularization for non-culprit lesions in ST-segment elevation myocardial infarction with multivessel disease: a meta-analysis of randomized controlled trials

Article References: Mok, J.-S., Byun, S., Her, S.-H., & Kim, D.-B. (2026). Timing of revascularization for non-culprit lesions in ST-segment elevation myocardial infarction with multivessel disease: a meta-analysis of randomized controlled trials. BMC Cardiovascular Disorders. https://doi.org/10.1186/s12872-026-07005-y

Image Credits: AI Generated

DOI: 10.1186/s12872-026-07005-y

Keywords: ST-segment elevation myocardial infarction, STEMI, multivessel disease, coronary artery disease, complete revascularization, immediate complete revascularization, staged complete revascularization, percutaneous coronary intervention, major adverse cardiovascular events, all-cause mortality, cardiac death, myocardial infarction, unplanned revascularization, randomized controlled trials, meta-analysis, cardiology