Yasmin Farah, Zaidi Syeda Farwa, Moeed Abdul, Shahzad Maryam, Asghar Muhammad Sohaib, Sadiq Mahnoor, Iqbal Javed, Surani Salim, Alraies M Chadi
Yale School of Medicine, New Haven, Connecticut, USA.
Dow Medical College, Karachi, Pakistan.
Clin Cardiol. 2025 Mar;48(3):e70105. doi: 10.1002/clc.70105.
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.
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.
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).
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.
近期针对多支冠状动脉疾病（MVD）所致急性冠状动脉综合征（ACS）的指南建议，在直接经皮冠状动脉介入治疗（PCI）后对非罪犯病变进行血运重建。然而，该手术的最佳时机——是即刻进行还是分期进行——仍不确定。
通过使用PubMed（MEDLINE）、Cochrane中心和谷歌学术进行全面检索，以确定比较接受PCI的MVD患者即刻和分期血运重建方法临床结局的研究。采用随机效应模型计算二分类结局的风险比（RRs）及95%置信区间（CIs）。主要结局为1年全因死亡率。
分析纳入了总共10项随机对照试验（RCTs），包括3886例患者（即刻血运重建组1964例，分期血运重建组1940例），中位随访时间为12个月。两种方法在1年死亡率风险方面未观察到显著差异。与分期血运重建组相比，即刻血运重建组在1年随访时的靶血管血运重建（TVR）风险显著更低（RR：0.64；95%CI：0.47 - 0.86；I²：0%；p = 0.03）。此外，即刻血运重建组在1年随访时发生心肌梗死（MI）的风险比分期方法显著更低（RR：0.57；95%CI：0.37 - 0.88；I²：10%；p = 0.01）。
这项荟萃分析表明，与分期血运重建相比，即刻血运重建在1年时TVR和MI风险显著更低。
