Clinical Outcomes of Immediate Versus Staged Revascularization of Nonculprit Arteries in Patients With Acute Coronary Syndrome: A Systematic Review and Meta-Analysis

IF 2.3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Clinical Cardiology Pub Date : 2025-03-11 DOI:10.1002/clc.70105

Farah Yasmin, Syeda Farwa Zaidi, Abdul Moeed, Maryam Shahzad, Muhammad Sohaib Asghar, Mahnoor Sadiq, Javed Iqbal, Salim Surani, M. Chadi Alraies

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Abstract

Background

Recent guidelines for acute coronary syndrome (ACS) with multivessel coronary artery disease (MVD) recommend revascularization of non-culprit lesions following primary percutaneous coronary intervention (PCI). However, the optimal timing for this procedure—whether immediate or staged—remains uncertain.

Methods

A comprehensive search using PubMed (MEDLINE), Cochrane Central, and Google Scholar was conducted to identify studies comparing clinical outcomes between immediate and staged revascularization approaches in patients with MVD undergoing PCI. A random effects model was used to calculate risk ratios (RRs) for dichotomous outcomes with 95% confidence intervals (CIs). The primary outcome was 1-year all-cause mortality.

Results

A total of 10 randomized controlled trials (RCTs), comprising 3886 patients (1964 in the immediate revascularization group and 1940 in the staged revascularization group), with a median follow-up of 12 months, were included in the analysis. No significant difference in the risk of 1-year mortality was noted between the two approaches. The risk of target vessel revascularization (TVR) at 1-year follow-up was significantly lower in the immediate revascularization group compared to the staged revascularization group (RR: 0.64; 95% CI: 0.47–0.86; I²: 0%; p = 0.03). Additionally, the immediate revascularization group had a significantly lower risk of myocardial infarction (MI) at 1-year follow-up than the staged approach (RR: 0.57; 95% CI: 0.37–0.88; I²: 10%; p = 0.01).

Conclusion

This meta-analysis suggests that immediate revascularization is associated with a significantly lower risk of TVR and MI at 1-year compared to staged revascularization.

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急性冠脉综合征患者非元凶动脉立即与分期血运重建的临床结果：系统回顾和荟萃分析

背景：急性冠脉综合征（ACS）合并多支冠状动脉疾病（MVD）的最新指南推荐在经皮冠状动脉介入治疗（PCI）后对非罪魁祸首病变进行血运重建。然而，这个过程的最佳时机——是立即还是分阶段进行——仍然不确定。方法利用PubMed （MEDLINE）、Cochrane Central和谷歌Scholar进行综合检索，以确定比较MVD患者行PCI时即刻和分期血运重建术临床结果的研究。采用随机效应模型计算具有95%置信区间（ci）的二分类结果的风险比（rr）。主要终点为1年全因死亡率。结果共纳入10项随机对照试验（RCTs），共3886例患者（立即血运重建术组1964例，分期血运重建术组1940例），中位随访时间为12个月。两种方法的1年死亡率无显著差异。1年随访时，即刻血管重建术组的靶血管重建术（TVR）风险明显低于分期血管重建术组(RR: 0.64；95% ci: 0.47-0.86；我²:0%;p = 0.03)。此外，立即血运重建术组在1年随访时心肌梗死（MI）的风险明显低于分期治疗组(RR: 0.57；95% ci: 0.37-0.88；我²:10%;p = 0.01)。结论：该荟萃分析表明，与分期血运重建术相比，立即血运重建术与1年TVR和MI风险显著降低相关。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical Cardiology 医学-心血管系统

CiteScore

5.10

自引率

3.70%

发文量

189

审稿时长

4-8 weeks

期刊介绍： Clinical Cardiology provides a fully Gold Open Access forum for the publication of original clinical research, as well as brief reviews of diagnostic and therapeutic issues in cardiovascular medicine and cardiovascular surgery. The journal includes Clinical Investigations, Reviews, free standing editorials and commentaries, and bonus online-only content. The journal also publishes supplements, Expert Panel Discussions, sponsored clinical Reviews, Trial Designs, and Quality and Outcomes.