Abstract 18145: Meta-Analysis Comparing Immediate and Staged Complete Revascularization for Multivessel Disease in Acute Coronary Syndrome Patients

Abstract

Background: Acute coronary syndrome (ACS) patients undergoing PCI often have severe non-culprit vessel involvement known as multivessel disease (MVD), which is linked to worse outcomes. While guidelines recommend complete revascularization, the optimal timing is unclear. Comparing immediate vs. staged approaches is crucial to identify the optimal approach to revascularization. Research question: Do outcomes differ between immediate complete revascularization (ICRV) and staged complete revascularization (SCRV) in patients with ACS and MVD? Methods: PubMed, Cochrane library and Web of Science were searched for studies comparing immediate vs. staged complete revascularization for ACS and MVD. Randomized controlled trials (RCTs) and prospective studies reporting all-cause mortality, major adverse cardiac events (MACE), myocardial infarction (MI), and revascularization were included. Thirty-day and extended-term outcomes were evaluated, and risk ratios (RR) with 95% confidence intervals (CIs) were calculated using a random-effects model. Results: The meta-analysis comprised 6 RCTs and 5 prospective studies, involving 3,631 patients (ICRV: 1,728; SCRV: 1,903) presenting with ACS (ST-elevation MI (STEMI)=9, NSTEMI=1; Mixed=2). The mean age was 62.4 ± 9.4 years, with 79.5% male. The ICRV group exhibited significantly higher 30-day mortality (RR: 2.19 [1.31-4.06], p=0.004), while the SCRV group had higher revascularization rates at 30 days and extended term (RR: 0.27 [0.10-0.69], p=0.007 and RR: 0.68 [0.48-0.96], p=0.03, respectively). No significant difference was found in 30-day and extended-term MACE and MI between the ICRV and SCRV groups. Conclusion: Although there was no significant difference in overall MACE between the two complete revascularization strategies for patients with ACS and MVD, the SCRV group showed lower 30-day all-cause mortality, while the ICRV group demonstrated a lower incidence of revascularization rates.