Immediate versus staged complete revascularization in acute coronary syndrome: A meta-analysis of randomized controlled trials

Kamil Bujak; Riccardo Rinaldi; Pablo Vidal-Cales; Rocco Antonio Montone; Roberto Diletti; Mariusz Gąsior; Filippo Crea; Manel Sabaté; Salvatore Brugaletta

doi:10.1016/j.ijcard.2023.131397

Immediate versus staged complete revascularization in acute coronary syndrome: A meta-analysis of randomized controlled trials

Int J Cardiol. 2023 Dec 15:393:131397. doi: 10.1016/j.ijcard.2023.131397. Epub 2023 Sep 26.

Authors

Kamil Bujak¹, Riccardo Rinaldi², Pablo Vidal-Cales³, Rocco Antonio Montone⁴, Roberto Diletti⁵, Mariusz Gąsior⁶, Filippo Crea⁴, Manel Sabaté³, Salvatore Brugaletta⁷

Affiliations

¹ Hospital Clínic, Cardiovascular Clinic Institute, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; 3rd Department of Cardiology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland.
² Hospital Clínic, Cardiovascular Clinic Institute, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy.
³ Hospital Clínic, Cardiovascular Clinic Institute, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
⁴ Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy.
⁵ Erasmus University Medical Center, Rotterdam, the Netherlands.
⁶ 3rd Department of Cardiology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland.
⁷ Hospital Clínic, Cardiovascular Clinic Institute, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain. Electronic address: sabrugaletta@gmail.com.

PMID: 37769973
DOI: 10.1016/j.ijcard.2023.131397

Abstract

Background: Clinical guidelines recommend a complete revascularization (CR) in patients with acute coronary syndromes (ACS) and multivessel disease (MVD). However, its optimal timing is unclear. The aim of this meta-analysis was to compare the clinical outcomes following immediate versus staged CR in ACS.

Methods: PubMed and Scopus were searched until March 2023 for randomized controlled trials (RCTs) comparing immediate versus staged CR. The primary endpoint was major adverse cardiovascular event (MACE) at the longest follow-up. Secondary outcomes were all-cause death, cardiovascular death, myocardial infarction (MI), any unplanned revascularization, target-vessel revascularization (TVR), and stent thrombosis. Safety outcomes were major bleeding, contrast volume, procedure duration, and length of hospitalization.

Results: Eight RCTs were included (3559 patients, weighted mean follow-up 12.5 months). There were no differences in the primary endpoint (OR 0.74, 95%CI: 0.54-1.01) and in the secondary endpoints of death, and stent thrombosis between the two CR strategies. Immediate CR was associated with a lower risk of recurrent MI (OR 0.51, 95% CI 0.34-0.76), any unplanned revascularization (OR 0.59, 95%CI: 0.43-0.80), and TVR (OR 0.61, 95% CI 0.45-0.84) compared to staged CR. Immediate CR was also associated with lower total contrast volume and shorter total procedure duration and hospitalization length compared to staged CR without differences in major bleedings.

Conclusion: No difference was found between immediate and staged CR regarding MACE, or deaths rates at one year. Immediate CR may be associated with a lower risk of recurrent MI and unplanned coronary revascularization than staged CR.

Keywords: Acute coronary syndrome; Complete revascularization; Multivessel disease; Prognosis; Staged procedure.