Coronary disease & ACSMeta-analysis
Optimal Strategy for Complete Revascularization in ST-Segment Elevation Myocardial Infarction and Multivessel Disease
- Systematic review and network meta-analysis of randomised trials
- PUBMED and EMBASE searched through July 2024
Authors' conclusion
Among patients with STEMI and multivessel disease, outcomes were better with immediate or staged CR compared with culprit vessel-only treatment, whether with angiographic or functional guidance.
Study context
- Population
- Patients with STEMI and multivessel coronary artery disease
- Participants
- 15,902 patients · 26 RCTs
- Comparison
- Immediate complete revascularization (CR) vs staged CR vs culprit vessel-only revascularization
- Outcome
- MACE
- Follow-up
- Mean weighted 25.2 ± 15.7 months
Pooled result
As reported in the abstract
Relative risk (95% CI)
Immediate CR vs Culprit vessel-only
0.48(0.36–0.64)
Staged CR vs Culprit vessel-only
0.65(0.52–0.82)
Immediate CR vs Staged CR
0.74(0.56–0.97)
Further pooled results
| Outcome | RR (95% CI) | |
|---|---|---|
| MACE, immediate vs staged CR, by guidance — Immediate CR vs Staged CR · angiographically guided · benefit caused by reductions in MI | 0.77 (0.61–0.99) | |
| MACE, immediate vs staged CR, by guidance — Immediate CR vs Staged CR · functionally guided · benefit caused by reductions in MI | 0.49 (0.27–0.89) | |
| MI, immediate vs staged CR (studies reporting all and nonprocedural MI) — Immediate CR vs Staged CR · with procedural MI | 0.44 (0.27–0.71) | |
| MI, immediate vs staged CR (studies reporting all and nonprocedural MI) — Immediate CR vs Staged CR · without procedural MI | 0.65 (0.36–1.16) | |
| 0.20.5125Relative risk (log scale) |
Original publication
Optimal Strategy for Complete Revascularization in ST-Segment Elevation Myocardial Infarction and Multivessel Disease. J Am Coll Cardiol. Published 7 January 2025. doi:10.1016/j.jacc.2024.09.1231
Summarised from the published abstract; every number is checked against it