Cardiovascular Revascularization Medicine最新文献

{"title":"Drug-coated balloon: It's debatable","authors":"Spencer B. King, III","doi":"10.1016/j.carrev.2026.08.001","DOIUrl":"10.1016/j.carrev.2026.08.001","url":null,"abstract":"","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":"90 ","pages":"Pages 66-67"},"PeriodicalIF":2.3,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148727390","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Vessel-specific angiography-derived index of microcirculatory resistance in an all-comer population undergoing percutaneous coronary intervention, a PIONEER IV trial substudy","authors":"Chris Lenselink,&nbsp;Kim Ricken,&nbsp;Tsung-Ying Tsai,&nbsp;Mick Renkens,&nbsp;Maria Papavasileiou,&nbsp;Sanne Stuiver,&nbsp;Erik Lipsic,&nbsp;Adriaan Voors,&nbsp;Yoshinobu Onuma,&nbsp;Patrick Serruys,&nbsp;Joanna Wykrzykowska","doi":"10.1016/j.carrev.2025.12.017","DOIUrl":"10.1016/j.carrev.2025.12.017","url":null,"abstract":"<div><h3>Background</h3><div>Recently, angiography-derived index of microvascular resistance (angio-IMR) has emerged as a less invasive alternative to estimate CMD during cardiac catheterization. Whether CMD differs across vessel territories and populations remains disputed.</div></div><div><h3>Methods</h3><div>Consecutive all-comer patients undergoing coronary angiography for chronic coronary syndrome (CCS) or non-ST-elevation myocardial infarction (NSTEMI) enrolled in the PIONEER-IV trial at the University Medical Center Groningen were included. Angio-IMR was retrospectively calculated using quantitative flow ratio (QFR) software in all three major coronary vessel territories pre- and post-PCI, if applicable. Angio-IMR levels were compared between coronary vessels, indication, and sex. The association between angio-IMR and LV function on AI-derived echocardiography analyses were assessed.</div></div><div><h3>Results</h3><div>In 220 patients, mean age was 65 ± 9 years, 18.3 % were women, and 20.3 % presented with NSTEMI. CMD was common: 80.0 % had baseline angio-IMR ≥25 mmHg·s/cm. Angio-IMR was similar in the LAD, RCA and LCX in both target and non-target vessels (<em>p</em> &gt; 0.05). In the LAD, angio-IMR increased significantly post-PCI (<em>p</em> &lt; 0.001), while RCA and LCX showed no significant change. Whilst NSTEMI patients showed similar baseline angio-IMR as CCS patients, they had lower post-PCI angio-IMR (<em>p</em> = 0.011). Women had lower average post-PCI angio-IMR (27 vs. 37 mmHg·s/cm, <em>p</em> &lt; 0.001) and showed improved microvascular resistance post-PCI. Angio-IMR was not associated with cardiac function overall, but in NSTEMI patients, higher baseline angio-IMR correlated with worse LV function.</div></div><div><h3>Conclusion</h3><div>Angio-IMR is similar in all coronary vessels, but lower in NSTEMI patients than in CCS and lower in women. In NSTEMI patients, higher IMR was associated with worse LV function.</div></div>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":"90 ","pages":"Pages 16-22"},"PeriodicalIF":2.3,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145935739","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Targeting inflammation to prevent conduction injuries following TAVI: A systematic review and meta-analysis of glucocorticoid therapy.","authors":"Ricardo F O Suruagy-Motta, Caio de Omena S Calheiros, Júlia Agra Silva, Marcela Caracas Machado Borges, Déborah Eloyse Santos Freitas, Laila Leite Pacheco Vieira, Ana Beatriz P Aguiar-Barros, Maria Morena Rocha Firmino, Saulo Rodrigo Ramalho de Moraes, Alfredo Aurélio Marinho Rosa Filho, Clarissa Dall'Orto, João Ricardo Cordeiro Fernandes, Alberto Colella Cervone, Evandro Martins Filho, Gregg W Stone","doi":"10.1016/j.carrev.2026.08.020","DOIUrl":"https://doi.org/10.1016/j.carrev.2026.08.020","url":null,"abstract":"<p><strong>Introduction: </strong>Cardiac conduction disturbances are common after transcatheter aortic valve implantation (TAVI) and frequently require permanent pacemaker implantation (PPI), associated with worse outcomes. Glucocorticoids have been proposed to reduce conduction injury by limiting inflammation and edema.</p><p><strong>Aims: </strong>To assess whether peri-procedural glucocorticoid therapy reduces conduction complications compared to standard care in TAVI patients.</p><p><strong>Methods: </strong>Systematic review and meta-analysis following Cochrane Handbook and PRISMA 2020 guidelines. PubMed/MEDLINE, Embase, Scopus, Web of Science, and Cochrane Library were searched through 2026. Randomized controlled trials and observational studies evaluating peri-procedural glucocorticoids in adults undergoing TAVI were included. Random-effects models estimated pooled risk ratios (RRs) with 95% confidence intervals (CIs).</p><p><strong>Results: </strong>Nine studies (8841 patients) were analyzed. Glucocorticoid therapy did not reduce pacemaker implantation (RR 0.91, 95% CI 0.73-1.14), new-onset left bundle branch block (RR 0.94, 95% CI 0.71-1.24), or acute kidney injury (RR 1.10, 95% CI 0.69-1.74). Mortality did not differ between groups (RR 0.94, 95% CI 0.61-1.45). Conversely, glucocorticoids were associated with increased bleeding (RR 1.39, 95% CI 1.01-1.90) and vascular complications (RR 1.86, 95% CI 1.36-2.55).</p><p><strong>Conclusion: </strong>Peri-procedural glucocorticoid therapy does not reduce conduction-related complications following TAVI and is associated with increased bleeding and vascular complications. These findings suggest caution regarding routine glucocorticoid use in contemporary TAVI practice.</p>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148892533","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between early repolarization and coronary slow flow phenomenon.","authors":"Lior R Shoev, Mordechai Hartman, Nitay A Handler, Ortal Tuvali, Gal Sella, Igor Volodarsky, Sagi Tshori, Gera Gandelman, Alex Baltt, Jacob George, Dan Haberman","doi":"10.1016/j.carrev.2026.08.017","DOIUrl":"https://doi.org/10.1016/j.carrev.2026.08.017","url":null,"abstract":"<p><strong>Background: </strong>Early repolarization pattern (ERP) has been associated with electrical instability, while coronary slow flow phenomenon (CSFP) reflects delayed contrast transit without obstructive coronary disease. We evaluated the association between ERP, quantitative repolarization markers, and CSFP.</p><p><strong>Methods: </strong>This retrospective study screened 753 patients who underwent coronary angiography. After applying the inclusion and exclusion criteria, 50 patients aged 18-60 years were included in the final cohort. CSFP was defined as a corrected TIMI frame count (CTFC) >27 in at least one epicardial artery. Electrocardiograms were reviewed for the presence of ERP and quantitative repolarization markers. Group comparisons and univariable logistic regression.</p><p><strong>Results: </strong>Among 50 patients selected for quantitative CTFC analysis, 32 (64%) met criteria for CSFP. ERP was more frequent in patients with CSFP than in those with normal CTFC (71.9% vs. 22.2%, p < 0.005) and was associated with CSFP in univariable analysis (OR 8.94, 95% CI 2.31-34.58). T-wave and J-peak amplitudes were also higher in the CSFP group and were associated with CSFP per 0.1 mV increase (T-wave amplitude: OR 2.87, 95% CI 1.47-5.59; J-peak amplitude: OR 42.44, 95% CI 6.08-296.26). Male sex and higher hemoglobin were also associated with CSFP in univariable analyses. The wide confidence intervals, particularly for J-peak amplitude and male sex, reflect the limited precision of these estimates given the modest sample size.</p><p><strong>Conclusion: </strong>ERP and quantitative repolarization markers were associated with CTFC-defined CSFP in this selected cohort. The findings suggest a potential relationship between ventricular repolarization features and delayed coronary transit but should be considered exploratory and hypothesis-generating.</p>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148888813","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical outcomes of excimer laser coronary atherectomy (ELCA) in percutaneous coronary intervention: A 10-year single-centre experience.","authors":"Ahmed Elsherif, Hossameldin Hussein, Sharvari Mahajan, Pouya Ebrahimi, Sophia Khattak, Ameenathul Fawzy, Hamidreza Soleimani, Farhan Shahid, Sohail Q Khan","doi":"10.1016/j.carrev.2026.08.013","DOIUrl":"https://doi.org/10.1016/j.carrev.2026.08.013","url":null,"abstract":"<p><strong>Background: </strong>Excimer laser coronary atherectomy (ELCA) is used in complex percutaneous coronary intervention (PCI), but contemporary long-term data across indications remain limited.</p><p><strong>Methods: </strong>We retrospectively included consecutive adults undergoing ELCA-assisted PCI at a tertiary centre from 2015 to 2025. Procedural and in-hospital outcomes were assessed in all patients. Long-term time-to-first major adverse cardiac events (MACE; target-vessel revascularisation, non-fatal myocardial infarction, or all-cause death) were evaluated among patients discharged alive.</p><p><strong>Results: </strong>62 patients were included (median age, 69.5 years [IQR 58-76]; 27.4% female). Calcified balloon-uncrossable lesions (33.9%) and in-stent restenosis (ISR; 30.6%) were the most common indications; 40.3% presented with non-ST-elevation ACS and 12.9% with STEMI. Technical success was achieved in 91.9%; 80.6% also met a composite of freedom from complications and in-hospital death. Complications occurred in 6 patients (9.7%) and in-hospital death in 4 (6.5%). Among 58 patients discharged alive, 24 (41.4%) experienced MACE over a median 49 months [IQR 8-99], driven by target-vessel revascularisation (29.3%); Kaplan-Meier event-free survival was 93.1% at 30 days, 81.8% at one year, 73.2% at two years and 60.0% at five years. In multivariable analysis, prior CABG (HR 9.64, 95% CI 3.43-27.10), diabetes (HR 3.76, 1.52-9.32) and ISR (HR 4.25, 1.48-12.19) were independent predictors of MACE.</p><p><strong>Conclusions: </strong>In this 10-year single-centre series, ELCA-assisted PCI achieved high technical success with acceptable in-hospital outcomes in a high-risk cohort, although long-term MACE remained frequent, driven predominantly by target-vessel revascularisation.</p>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148913827","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of operator and institutional annual case volume on percutaneous coronary intervention clinical outcomes.","authors":"Riley J Batchelor, Diem Dinh, Jocasta Ball, Malanka Lankaputhra, Jason E Bloom, Christopher M Reid, Antony Walton, Andrew Wilson, William Chan, William van Gaal, Derek P Chew, Anoop Koshy, David M Kaye, Andrew J Taylor, Jeffrey Lefkovits, Dion Stub","doi":"10.1016/j.carrev.2026.08.018","DOIUrl":"https://doi.org/10.1016/j.carrev.2026.08.018","url":null,"abstract":"<p><strong>Background: </strong>Percutaneous coronary intervention (PCI) is one of the most frequently performed procedures and is being undertaken in increasingly complex patient populations. International studies have suggested an association between operator or institutional procedural volume and PCI outcomes, largely reflecting differences in experience and performance.</p><p><strong>Methods: </strong>All adult procedures registered in the Victorian Cardiac Outcomes Registry undergoing PCI in Victoria, Australia between 1 January 2015 and 31 December 2024 were included. Operators were classified as low (<50 PCI/year), medium (50-99), or high (≥100), and institutions as low (<200), medium (200-399), or high (≥400) annual PCI volume. Multivariable logistic regression clustered at the hospital level assessed associations between operator volume and in-hospital mortality.</p><p><strong>Results: </strong>Across 34 institutions and 157 operators, 117,237 PCI procedures were analysed. High-volume operators performed 72.0% of all procedures, compared with 21.9% by medium-volume and 6.1% by low-volume operators. Similarly, high-volume institutions accounted for 71.2% of PCI, with 21.8% and 7.0% performed at medium- and low-volume centres, respectively. High-volume operators and institutions managed greater proportions of high-risk presentations (STEMI, out-of-hospital cardiac arrest, cardiogenic shock) and demonstrated comparable adjusted outcomes. Key PCI quality indicators such as radial access, coronary imaging use, and faster door-to-balloon times were more common among high-volume operators and institutions. After multivariable adjustment, neither operator nor institutional volume was independently associated with in-hospital mortality.</p><p><strong>Conclusion: </strong>In contemporary Australian PCI practice, important differences in PCI care metrics were observed between high- and low-volume operators and institutions. Although a substantial proportion of PCI is performed by operators not meeting current national volume standards, adjusted survival was not independently associated with operator or institutional volume. Consistent with European data, these findings highlight the importance of performance monitoring and suggest that minimum PCI standards in Australia and comparable mixed public-private systems may need to be reviewed to focus more on quality metrics, rather than procedural volume alone.</p>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148882039","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"DK-crush versus mini-crush: Beyond the P value.","authors":"Ezgi Gültekin Güner, Kaan Gökçe, Ahmet Güner","doi":"10.1016/j.carrev.2026.08.014","DOIUrl":"https://doi.org/10.1016/j.carrev.2026.08.014","url":null,"abstract":"","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148851492","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Balloon angioplasty for coronary artery disease: Best practices in the DCB era.","authors":"Shreesh Kalagi, Ricardo O Escarcega, Angela M Taylor, Michael Ragosta, George W Vetrovec, Michael J Lipinski","doi":"10.1016/j.carrev.2026.08.015","DOIUrl":"https://doi.org/10.1016/j.carrev.2026.08.015","url":null,"abstract":"<p><p>As percutaneous coronary intervention with drug-coated balloon (DCB) increases, it will be critical to revisit criteria to define an optimal balloon angioplasty result. Given the importance of adequate vessel preparation prior to consideration of DCB utilization, many interventional cardiologists may be unfamiliar with what percentage of residual stenosis is considered acceptable following balloon angioplasty and which coronary dissections are safe to leave. Intravascular imaging may provide a powerful tool to aid in determining which lesions are safe to proceed with DCB use following vessel preparation and which lesions require bailout stenting. As DCB use expands into the treatment of de novo coronary lesions in the United States, employment of best practices and understanding whether a balloon angioplasty result is optimal will be critical for successful adoption of DCB technology.</p>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148867276","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes of single versus double Perclose suture device use after transfemoral transcatheter procedures using large-bore arterial access: A meta-analysis and systematic review.","authors":"Priyesh Thakurathi, JuYong Lee, Michael G Nana, Shrija Thapa, Rupesh Kshetri, Agnes S Kim, Raymond G McKay, Khagendra Dahal","doi":"10.1016/j.carrev.2026.08.012","DOIUrl":"https://doi.org/10.1016/j.carrev.2026.08.012","url":null,"abstract":"<p><strong>Background: </strong>In large-bore transfemoral procedures such as transcatheter aortic valve replacement and endovascular aneurysm repair, the comparative effectiveness of single (SP) versus the default double Perclose (DP) strategies for arterial closure remains uncertain.</p><p><strong>Methods: </strong>We performed a systematic literature search in PubMed, Scopus, Web of Science, and the Cochrane Library from January 2014 to April 2026 to identify studies comparing SP and DP devices for large-bore transfemoral arterial access closure. Outcomes included device/technical success, need for unplanned surgical or catheter-based intervention, 30-day mortality, any vascular complication, major bleeding, arterial dissection, and arterial stenosis. Random-effects meta-analysis using inverse-variance weighting was performed, and heterogeneity was assessed using the I² statistic.</p><p><strong>Results: </strong>We identified 14 studies published or available between 2015 and 2026, comprising 6487 patients before matching or adjustment (SP 3518; DP 2969). Post-matching adjusted cohorts comprised 5077 patients (SP 2691; DP 2386). Comparing SP with DP, device/technical success was similar (RR 1.02, 95% CI 1.00-1.03; P = 0.07), as was the need for unplanned surgical/catheter intervention (RR 0.77, 95% CI 0.54-1.09; P = 0.14). There were no significant differences in overall vascular complications (RR 0.78, 95% CI 0.59-1.04; P = 0.09), major bleeding (RR 0.83, 95% CI 0.51-1.36; P = 0.46), arterial stenosis (RR 0.81, 95% CI 0.55-1.20; P = 0.30), or 30-day mortality (RR 0.99, 95% CI 0.65-1.50; P = 0.96). However, SP was associated with a lower risk of arterial dissection (RR 0.32, 95% CI 0.15-0.70; P = 0.004).</p><p><strong>Conclusion: </strong>In large-bore transfemoral transcatheter procedures, a single Perclose strategy was associated with a lower risk of arterial dissection compared to double Perclose and no significant difference for other major outcomes and complications.</p>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148881973","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Timing of non-culprit revascularization in STEMI with multivessel disease: A contemporary meta-analysis of immediate and staged strategies.","authors":"Rubiya Ali, Muniba Naeem, Kamahl Harrisingh, Edgar Morales Arteaga, Holly Gaines, Jonathan S Roberts","doi":"10.1016/j.carrev.2026.08.009","DOIUrl":"https://doi.org/10.1016/j.carrev.2026.08.009","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Complete revascularization improves outcomes in ST-segment elevation myocardial infarction (STEMI) with multivessel coronary artery disease, but the optimal timing of non-culprit intervention-immediate, early-staged (same hospitalization), or delayed (post-discharge)-remains uncertain.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To evaluate the effect of timing of non-culprit revascularization in STEMI.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We performed a systematic review and meta-analysis of randomized trials comparing immediate, early-staged, and delayed-staged non-culprit revascularization in STEMI. DerSimonian-Laird random-effects models pooled risk ratios (RR) with 95% confidence intervals (CI); fixed-effect and REML sensitivity analyses and parallel hard-endpoint (death plus myocardial infarction) analyses were performed.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Five randomized trials contributed to the pooled timing comparisons. Versus early-staged revascularization, immediate complete PCI was not associated with improved outcomes (three trials; RR 1.25, 95% CI 0.92-1.70; I&lt;sup&gt;2&lt;/sup&gt; = 0%). Versus delayed-staged strategies, immediate PCI showed a numerical event reduction (RR 0.73, 95% CI 0.37-1.45) with substantial heterogeneity (I&lt;sup&gt;2&lt;/sup&gt; ≈ 88%), driven by discordant results between MULTISTARS AMI and iMODERN, the latter a hybrid strategy-plus-timing (physiology- versus imaging-guided) rather than a pure timing comparison. Hard-endpoint analyses showed no significant difference; where reported, contrast-induced nephropathy and major bleeding did not differ.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Immediate complete revascularization showed no clear difference in outcomes versus staged revascularization during the same hospitalization; as most trials were not powered for non-inferiority, this should not be read as equivalence. These findings support an individualized approach emphasizing timely completion rather than routine immediate multivessel PCI in stable STEMI, with staged PCI favored when lesions are complex, renal function is impaired, or physiology-guided assessment is preferred.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Condensed abstract: &lt;/strong&gt;In this meta-analysis of direct-timing randomized trials, immediate multivessel PCI showed no benefit versus in-hospital staged revascularization and only inconsistent benefit versus delayed strategies. These data support immediate non-culprit PCI in the hemodynamically stable patient with a non-complex culprit intervention and anticipated non-complex non-culprit PCI, and staged in-hospital PCI as an equally pragmatic default, in stable STEMI with multivessel disease. Because the potential downside of brief post-discharge deferral (within 30-45 days) appears small, selected patients-such as those with significant acute kidney injury after index PCI or functionally vulnerable elderly patients who would benefit from earlier discharge-may reasonably undergo planned outpatient non-culprit revascularizatio","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148833600","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}