Meta-analysis shows no significant difference between immediate and staged revascularization for STEMI with multivessel disease

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The American journal of cardiology Published May 15, 2026 Medically reviewed May 15, 2026 Study authors: Harmouch Wissam, Thakker Ravi, Shah Samit, Attaran Robert, Alqarqaz Mohammad, Basir Mir Babar, Anout… PubMed ↗ DOI ↗ By Dr. Amelia Tan, PhD · Internal Medicine & Chronic Disease

Key Takeaway

Note that immediate revascularization does not significantly improve outcomes compared to staged revascularization in this patient population.

This systematic review and meta-analysis examined patients with ST-elevation myocardial infarction and multivessel disease to compare immediate versus staged complete revascularization strategies. The study population was predominantly male with an average age in the mid-sixties. Researchers assessed major adverse cardiovascular events along with all-cause mortality, recurrent myocardial infarction, and various safety endpoints including stroke and major bleeding.

The analysis found no significant difference in major adverse cardiovascular events between the two groups. Similarly, mortality rates and risks of recurrent myocardial infarction or unplanned revascularization were comparable regardless of the timing of the procedure. Safety outcomes such as stroke, major bleeding, and acute nephropathy were also observed to be similar between the immediate and staged approaches.

The authors noted heterogeneity across the included randomized controlled trials and acknowledged that some trials excluded left main disease or utilized intravascular imaging. While findings were consistent across sensitivity analyses, the presence of heterogeneity warrants caution. The practice relevance supports a revascularization approach that incorporates anatomic complexity, physiology, procedural logistics, and patient-specific factors when determining optimal timing.

Study Details

Study typeMeta analysis

Sample sizen = 4,472

EvidenceLevel 1

Follow-up18.5 mo

PublishedMay 2026

PMID41812921

View Original Abstract ↓

Complete revascularization (CR) in patients with ST-segment elevation myocardial infarction (STEMI) and multivessel disease (MVD) is recommended, but the timing of revascularization, either immediate or staged remains a topic of debate. A systematic search of MEDLINE, Scopus, and Cochrane databases was performed to identify randomized controlled trials (RCTs) that evaluated patients with STEMI and MVD and compared outcomes between immediate CR versus staged CR. The primary outcome was major adverse cardiovascular events. Eleven RCTs were included in this analysis with 4,472 patients assessed at a weighted mean follow-up of 18.5 months. Patients were 79% male with an average age of 64 years. Five RCTs utilized some degree of intravascular imaging or physiology, 7 RCTs explicitly excluded left main (LM) disease, and 6 RCTs exclusively utilized drug-eluting stents (DES). Compared to staged CR, immediate CR did not significantly reduce the incidence of major adverse cardiovascular events (risk ratios [RR] 0.92 [0.73, 1.17]), all-cause mortality (RR 1.31 [0.97, 1.78]), cardiovascular mortality (RR 1.28 [0.87, 1.90]), recurrent myocardial infarction (MI) (RR 0.78 [0.57, 1.07]), unplanned revascularization (RR 0.87 [0.67, 1.14]), or stent thrombosis (RR 1.39 [0.79, 2.43]). Safety endpoints were comparable between both groups: stroke (RR 0.91 [0.51, 1.62]), major bleeding (RR 0.76 [0.49, 1.18]), and acute nephropathy (RR 0.88 [0.59, 1.31]). Sensitivity analysis demonstrated consistent findings regarding the primary outcome across all scenarios. Immediate and staged CR demonstrated similar efficacy and safety. In conclusion, these neutral findings were consistent despite heterogeneity across RCTs, and support a revascularization approach incorporating anatomic complexity, physiology, procedural logistics, and patient-specific factors when determining the optimal timing of CR in patients with STEMI and MVD.