Coronary disease & ACSMeta-analysis
Complete versus culprit lesion-only revascularisation for acute myocardial infarction (Complete Revascularisation Trialists' Collaboration): an individual patient data meta-analysis of randomised trials
- Individual patient data meta-analysis of randomised trials
- one-stage IPD meta-analysis (Cox frailty model)
- hierarchical testing
Authors' conclusion
In patients presenting with acute myocardial infarction and multivessel disease, complete revascularisation reduced the composite of cardiovascular death or new myocardial infarction as well as cardiovascular death alone compared with a culprit lesion-only PCI strategy. In addition, all-cause death was lower with complete revascularisation.
Study context
- Population
- Patients with acute STEMI or NSTEMI and multivessel CAD
- Participants
- 8,836 patients · 6 RCTs
- Comparison
- Complete revascularisation vs culprit lesion-only percutaneous coronary intervention (PCI)
- Complete revascularisationn = 4,259
- Culprit lesion-onlyn = 4,577reference
- Outcome
- Composite of:
- Cardiovascular death or new myocardial infarction
- Cardiovascular death alone (hierarchical)
Pooled result
As reported in the abstract
median follow-up 36.0 months (IQR 30.6-48.0)
Complete revascularisation
382 (9.0%) of 4259
CV death or new MI · CV death 155 (3.6%)
Culprit lesion-only
528 (11.5%) of 4577
CV death or new MI · CV death 209 (4.6%)
Complete revascularisation vs Culprit lesion-onlyHazard ratio (95% CI)P value
CV death or new MI
0.76(0.67–0.87)
P < 0.0001CV death
0.76(0.62–0.93)
P = 0.0091Further pooled results
| Outcome | Complete revascularisation | Culprit lesion-only | HR (95% CI) | P value | |
|---|---|---|---|---|---|
| All-cause death | 7.2% | 8.1% | 0.85 (0.73–0.99) | P = 0.039 | |
| Non-CV death | 3.6% | 3.5% | 0.98 (0.78–1.22) | P = 0.85 | |
| New MI | 6.0% | 7.8% | 0.76 (0.65–0.90) | P = 0.0011 | |
| 0.512Hazard ratio (log scale) |
Original publication
Complete versus culprit lesion-only revascularisation for acute myocardial infarction (Complete Revascularisation Trialists' Collaboration): an individual patient data meta-analysis of randomised trials. Lancet. Published 9 November 2025. doi:10.1016/s0140-6736(25)02170-1
Summarised from the published abstract; every number is checked against it