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

Abstract

ABSTRACTBackgroundIn patients with acute coronary syndrome (ACS) and multivessel disease (MVD), complete revascularization (CR) improves prognosis. This meta‐analysis, summarizing recent RCTs, contrasts short‐term and long‐term clinical outcomes between immediate complete revascularization (ICR) and staged complete revascularization (SCR).MethodsWe systematically searched the online database and eight RCTs were involved. 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.ResultsEight RCTs comprising 5198 patients were involved. 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).ConclusionIn ACS patients with MVD, we first found that ICR significantly lowered the risk of both short‐term and long‐term unplanned ischemia‐driven revascularization and re‐infarction, as well as the long‐term composite outcome of CV death or MI compared with SCR. However, there may be an increase in 1‐month all‐cause death in the ICR group.