Timing of Complete Revascularization in Patients With STEMI and Multivessel Disease: An Updated Meta-Analysis of Randomized Clinical Trials

BACKGROUND: The ideal timing for complete revascularization (CR) in patients with ST-segment-elevation myocardial infarction and multivessel disease is uncertain. This meta-analysis examined outcomes of immediate CR (ICR) versus staged CR (SCR). METHODS: Four databases were searched for randomized controlled trials that compared ICR and SCR in ST-segment-elevation myocardial infarction and multivessel disease. The primary end points of interest were short-term and long-term all-cause mortality. Outcomes are presented as risk ratios for short-term outcomes and incidence rate ratios for long-term outcomes with 95% CIs. RESULTS: =0%). No significant differences were identified between the ICR and SCR strategies at either short-term or long-term follow-up for other outcomes, including myocardial infarction, repeat revascularization, stent thrombosis, stroke, major bleeding, and the composite of major adverse cardiac or cerebrovascular events. CONCLUSIONS: In hemodynamically stable patients with ST-segment-elevation myocardial infarction and multivessel disease, an ICR strategy may increase short-term cardiac death compared with SCR, and the possibility of increased early and late all-cause mortality cannot be excluded. Despite some uncertainty, these results currently favor a staged CR strategy for most patients with ST-segment-elevation myocardial infarction and multivessel disease. REGISTRATION: URL: https://www.crd.york.ac.uk/PROSPERO/; Unique identifier: CRD420251163719.