Circulation. Cardiovascular interventions · 2026
Timing of Complete Revascularization in Patients With STEMI and Multivessel Disease: An Updated Meta-Analysis of Randomized Clinical Trials.
СтатьяМетаанализСистематический обзорНазвание и аннотация: Перевод в очереди
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Elbahloul Mohammed A, Ramadan Shrouk, Labeeb Eman E, Aldalahmeh Shahed, Mousa Ahella Ismail A, Elazab Ahmed, Mohamed Ahmed N, Elashery Ahmad, El-Hamdani Mehiar O, Lavie Carl J, Stone Gregg W
Аннотация
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: The analysis included 9 randomized controlled trials in which 4213 patients were enrolled. Short-term all-cause mortality occurred in 2.0% of patients after ICR compared with 1.2% of patients after SCR (risk ratio, 1.66 [95% CI, 0.99-2.78], P=0.053; I2=0%). Short-term cardiac death was increased after ICR (risk ratio, 2.19 [95% CI, 1.08-4.44], P=0.03; I2=0%). At a median 1-year follow-up, all-cause mortality occurred in 4.7% of patients after ICR compared with 3.5% of patients after SCR (incidence rate ratio, 1.40 [95% CI, 0.97-2.03], P=0.07; I2=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.
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: The analysis included 9 randomized controlled trials in which 4213 patients were enrolled. Short-term all-cause mortality occurred in 2.0% of patients after ICR compared with 1.2% of patients after SCR (risk ratio, 1.66 [95% CI, 0.99-2.78], P=0.053; I2=0%). Short-term cardiac death was increased after ICR (risk ratio, 2.19 [95% CI, 1.08-4.44], P=0.03; I2=0%). At a median 1-year follow-up, all-cause mortality occurred in 4.7% of patients after ICR compared with 3.5% of patients after SCR (incidence rate ratio, 1.40 [95% CI, 0.97-2.03], P=0.07; I2=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.