Immediate versus staged complete revascularization using drug-eluting stents in patients with ST-segment elevation myocardial infarction and multivessel coronary artery disease: An updated meta-analysis after the OPTION-STEMI trial

BACKGROUND: Complete revascularization is recommended for patients with ST-segment elevation myocardial infarction (STEMI) and multivessel coronary artery disease. However, the optimal timing of non-culprit lesion percutaneous coronary intervention (PCI) remains controversial, ranging from treatment during the initial procedure to several weeks after the acute event. AIMS: We systematically searched MEDLINE, Scopus, and EMBASE through September 2025 for randomized controlled trials comparing immediate vs. staged complete revascularization with drug-eluting stents in patients presenting with STEMI and multivessel coronary artery disease undergoing primary PCI. METHODS: The primary endpoint was death from cardiac causes at a median follow-up of 12 months. Secondary endpoints were all-cause mortality, recurrent non-fatal myocardial infarction (MI), any unplanned revascularization, target-vessel revascularization, target-lesion revascularization, major bleeding, acute kidney injury, and stroke. RESULTS: Six randomized controlled trials including 2837 patients (1441 immediate and 1446 staged) were analyzed. At 12 months, death from cardiac cause occurred at comparable rates between strategies (risk ratio [RR], 0.99; 95% confidence interval [CI], 0.98-1.01; P = 0.33). No significant differences were observed for all-cause mortality (RR, 0.99; 95% CI, 0.97-1.00; P = 0.13), non-fatal MI (RR. 1.01; 95% CI, 0.99-1.04; P = 0.17), target vessel revascularization (RR, 1.00; 95% CI, 0.98-1.01; P = 0.48), or target lesion revascularization (RR, 1.00; 95% CI, 0.99-1.02; P = 0.34). Similarly, no differences were found for stroke (RR, 1.00; 95% CI, 0.99-1.01; P = 0.75), major bleeding (RR, 1.01; 95% CI, 0.99-1.03; P = 0.21), or AKI (RR, 1.00; 95% CI, 0.99-1.03; P = 0.79). Immediate complete revascularization may be associated with a trend towards lower rates of unplanned revascularization compared with staged PCI (RR, 0.97; 95% CI, 0.93-1.01; P = 0.09). CONCLUSIONS: In patients with STEMI and multivessel coronary disease, an immediate complete revascularization strategy showed comparable rates of death from cardiac cause and non-fatal MI as compared with staged complete revascularization at a median of 12 months of follow-up.