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.