Completeness of revascularization in multivessel coronary artery disease: a network meta-analysis protocol

Abstract Introduction Multivessel coronary artery disease (MCAD) is a common manifestation of ischaemic heart disease, associated with considerable morbidity and mortality. Revascularization using coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI) is standard practice for many patients. However, outcomes may depend on the completeness of revascularization—whether all ischaemic or anatomically significant lesions are treated—which is often suboptimal. Complete revascularization (CR) has been suggested to improve long-term outcomes compared to incomplete revascularization (IR), but head-to-head comparisons across modalities are limited. This protocol outlines the methodology for a systematic review and network meta-analysis (NMA) assessing complete vs incomplete revascularization via CABG and PCI in patients with MCAD. Methods and analysis This protocol follows Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA)-P and PRISMA-NMA guidelines and is registered with PROSPERO (CRD42024610743). A comprehensive search will be conducted in MEDLINE, Embase and Scopus to identify RCTs and observational studies comparing complete and incomplete revascularization in MCAD. Eligible studies must report at least one of the following outcomes with ≥12 months follow-up: all-cause mortality, myocardial infarction (MI), target vessel revascularization (TVR), stroke, major adverse cardiac events (MACE), or major adverse cardiac and cerebrovascular events (MACCE). Risk of bias will be assessed using RoB2 for RCTs and the Newcastle-Ottawa Scale for observational studies. A Bayesian NMA with random-effects modelling will be conducted using the BUGSnet package in R. Treatment ranking will be performed using surface under the cumulative ranking curve (SUCRA) values. Discussion This study will evaluate the impact of complete vs incomplete revascularization in MCAD, providing clarity on optimal strategies and informing patient-centred clinical decisions. Our findings will support clinicians in choosing revascularization methods that maximize long-term cardiovascular outcomes.