Comparison of Immediate Versus Staged Complete Revascularisation in Patients Presenting With Acute Coronary Syndrome and Multivessel Disease: A Meta-Analysis of Randomized and Non-randomized Studies

Abstract

Acute myocardial infarction is a critical medical condition that poses asignificant health burden, leading to substantial morbidity. Despiteadvancements in medical care, managing this condition is challenging forpatients and society. The preferred approach appears to be comprehensivemultivessel revascularization, yet the optimal timing remains uncertain.This study aims to compare immediate complete revascularisation and stagecomplete vascularization in patients presenting with acute coronarysyndrome (ACS) and multivessel coronary artery disease (MVD). ThePreferred Reporting of Systematic Reviews and Meta-analysis (PRISMA)guidelines conducted the present meta-analysis. A comprehensive literaturesearch was conducted using online databases, including PubMed, and EMBASEfrom 2010 onwards, to identify articles that compared cardiovascularoutcomes between patients undergoing immediate and staged completerevascularization. We also searched Google Scholar for additional studiesrelevant to the present meta-analysis. The primary outcome assessed inthis study was major adverse cardiovascular events (MACE). Secondaryoutcomes included all-cause mortality, cardiovascular mortality,myocardial infarction (MI), and revascularization. A total of 15 studiesfulfilled pre-defined eligibility criteria and were included in the finalanalysis. Our analysis shows that staged revascularization is associatedwith improved outcomes in patients with ACS and multivessel CAD, includingall-cause mortality and cardiovascular mortality, without increasing therisk of major adverse cardiovascular events, myocardial infarction, andthe need for unplanned revascularization. Copyright © 2023, Rawat et al.