The following is a summary of “Impact of Immediate Versus Staged Complete Revascularization on Short-Term and Long-Term Clinical Outcomes in Patients With Acute Coronary Syndrome and Multivessel Disease: A Systematic Review and Meta-Analysis,” published in the September 2024 issue of Cardiology by Jia et al.

In patients with acute coronary syndrome (ACS) and multivessel disease (MVD), complete revascularization (CR) improves prognosis.

Researchers conducted a retrospective study to contrast short-term and long-term clinical outcomes between immediate CR (ICR) and staged CR (SCR) in patients with ACS and MVD.

They systematically searched online databases and included 8 RCTs. The primary outcomes included long-term unplanned ischemia-driven revascularization, re-infarction, combined cardiovascular (CV) death or myocardial infarction (MI), all-cause death, CV death, stroke, and hospitalization for heart failure (HHF). The secondary outcomes were 1-month unplanned ischemia-driven revascularization, re-infarction, all-cause death, and CV death. Safety endpoints included stent thrombosis and major bleeding.

The results showed 8 RCTs comprising 5198 patients, ICR reduced long-term unplanned ischemia-driven revascularization (RR 0.64, 95% CI 0.51–0.81, P<0.001), combined CV death or MI (HR 0.51, 95% CI 0.34–0.78, P=0.002), and re-infarction (RR 0.66,95% CI 0.48 to 0.91, P=0.012) compared with SCR, ICR also decreased 1-month unplanned ischemia-driven revascularization (RR 0.41, 95% CI: 0.21–0.77, P=0.006) and re-infarction (RR 0.33, 95% CI:0.15–0.74, P=0.007) but increased 1-month all-cause death (RR 2.22, 95% CI 1.06–4.65, P=0.034).

Investigators found that ICR significantly lowered the risk of heart-related complications in patients with ACS and MVD, but there might be a slight increase in short-term death.

Source: onlinelibrary.wiley.com/doi/full/10.1002/clc.70011