Abstract 14388: Meta-Analysis of Randomized Controlled Trials Comparing Immediate vs Staged Complete Revascularization in Patients With Acute Coronary Syndrome

Abstract

Introduction: Complete revascularization with percutaneous coronary intervention (PCI) has been shown to improve clinical outcomes in patients with acute coronary syndromes (ACS) and multivessel disease (MVD). In order to address the conflicting results reported with respect to the timing, we aimed to perform a meta-analysis of the available randomized controlled trials (RCTs). Methods: Online databases were searched for RCTs comparing immediate to staged complete PCI in patients presenting with ACS. The primary outcomes of interest were major adverse cardiovascular events (MACE), all cause death, myocardial infarction (MI), cardiovascular death, stent thrombosis, target lesion revascularization (TLR), target vessel revascularization (TVR), cerebrovascular events and bleeding at the longest available follow up. Pooled risk ratios (RR) and 95% confidence intervals (CI) were calculated using a random-effects model. Results: Three RCTs with a total of 2,261 patients, with 1,131 in the immediate PCI group and 1,130 in the staged PCI group were included. The mean age was 67 years, 79% of patients were men and the mean duration of follow up was 1 year. The immediate PCI group compared to staged complete PCI was associated with a significant reduction in MI (RR 0.50, 95% CI 0.31-0.83, p = 0.007) (Figure 1) and TVR (RR 0.58, 95% CI 0.41-0.80, p = 0.001). There were similar risks of cardiovascular death (RR 1.15, 95% CI 0.55-2.42, p = 0.71), TLR (RR 0.88, 95% CI 0.17-4.65, p = 0.88), cerebrovascular events (RR 0.87, 95% CI 0.41-1.82, p = 0.71), all-cause death (RR 1.30, 95% CI 0.48-3.50, p = 0.61), MACE (RR 0.70, 95% CI 0.48-1.02, p = 0.06), stent thrombosis (RR 0.89, 95% CI 0.36-2.22, p = 0.81) and bleeding (RR 0.65, 95% CI 0.18-2.41, p = 0.52) between the two groups. Conclusions: Complete PCI of the culprit and non-culprit vessels during the index procedure (immediate) significantly reduces the risk of MI and TVR when compared with staged PCI.