SYSTEMATIC REVIEW article
Front. Cardiovasc. Med.
Sec. Coronary Artery Disease
Volume 12 - 2025 | doi: 10.3389/fcvm.2025.1626748
This article is part of the Research TopicOptimizing Revascularization and Conservative Therapy in Chronic Coronary SyndromeView all 12 articles
Immediate versus staged complete revascularisation in patients with acute coronary syndrome and multivessel disease: meta-analysis of randomized controlled trials
Provisionally accepted
- 1Nanchong hospital of Beijing Anzhen hospital, Nan chong, China
- 2Xihua University, Chengdu, China
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Background: A series of trials have confirmed that the complete revascularization could bring more benefits for patients with acute coronary syndrome (ACS) and multivessel disease than culprit-only revascularization. However, the optimal timing of complete revascularization remains controversial. It is unclear whether immediate complete revascularization is safer and more effective than staged complete revascularization. Method: This meta-analysis of randomized controlled trials aimed to compare the efficacy and safety of immediate versus staged revascularization in ACS patients. The primary outcome was major adverse cardiovascular events (MACE), defined as a composite endpoint. Risk ratios (RRs) were calculated using the Mantel-Haenszel (M-H) fixed-effect model. Trial sequential analysis (TSA) was additionally performed to validate the results. This study is registered with PROSPERO (CRD42023461852). Results: Eleven randomized studies involving 5,666 patients met the inclusion criteria. At a mean follow-up of 16 months, immediate complete revascularization significantly reduced the incidence of MACE compared with staged complete revascularization (RR: 0.76, 95% confidence interval [CI]: 0.66–0.89, P = 0.0004). Significant reductions were also observed in repeat myocardial infarction (RR: 0.59, 95% CI: 0.43–0.82, P = 0.002), repeat revascularization (RR: 0.62, 95% CI: 0.48–0.79, P = 0.0001), and the composite outcome of myocardial infarction or death (RR: 0.67, 95% CI: 0.48–0.92, P = 0.01). However, no significant differences were found in all-cause mortality (RR: 0.92, 95% CI: 0.64–1.33, P = 0.66) or cardiovascular mortality (RR: 0.96, 95% CI: 0.58–1.61, P = 0.89). Conclusion: In patients with ACS and multivessel disease, immediate complete revascularization significantly reduced the risks of MACE, repeat myocardial infarction and repeat revascularization, without increasing the risk of all - cause death. Keywords: Percutaneous coronary intervention, acute coronary syndrome, staged complete revascularization, immediate complete revascularization .
Keywords: Percutaneous Coronary Intervention, Acute Coronary Syndrome, Immediate complete revascularization, Staged complete revascularization, Multivessel disease (MVD)
Received: 11 May 2025; Accepted: 28 Aug 2025.
Copyright: © 2025 He, Zhong, Yang, Sun, Guo, Hu, Li and Zhao. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Peng-Yu Zhong, Nanchong hospital of Beijing Anzhen hospital, Nan chong, China
Jing-Hng Zhao, Nanchong hospital of Beijing Anzhen hospital, Nan chong, China
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