Wissam, H., Ravi, T., Samit, S., Robert, A., Mohammad, A., Babar, B.M., Khalil, A., Afaq, M., Umamahesh, R., & Hani, J. (2026). Optimal Timing of Complete Revascularization in Patients With ST-Elevation Myocardial Infarction and Multivessel Disease: A Systematic Review and Meta-Analysis.. The American journal of cardiology.
Wissam H, Ravi T, Samit S, Robert A, Mohammad A, Babar BM, et al. Optimal Timing of Complete Revascularization in Patients With ST-Elevation Myocardial Infarction and Multivessel Disease: A Systematic Review and Meta-Analysis.. The American journal of cardiology. 2026; PMID: 41812921
Wissam H, Ravi T, Samit S, et al. Optimal Timing of Complete Revascularization in Patients With ST-Elevation Myocardial Infarction and Multivessel Disease: A Systematic Review and Meta-Analysis.[J]. The American journal of cardiology. 2026.
@article{wissam2026,
author = {Harmouch Wissam and Thakker Ravi and Shah Samit and Attaran Robert and Alqarqaz Mohammad and Basir Mir Babar and Anouti Khalil and Motiwala Afaq and Rangasetty Umamahesh and Jneid Hani},
title = {Optimal Timing of Complete Revascularization in Patients With ST-Elevation Myocardial Infarction and Multivessel Disease: A Systematic Review and Meta-Analysis.},
journal = {The American journal of cardiology},
year = {2026},
note = {PMID: 41812921},
}
TY - JOUR AU - Harmouch Wissam AU - Thakker Ravi AU - Shah Samit AU - Attaran Robert AU - Alqarqaz Mohammad AU - Basir Mir Babar AU - Anouti Khalil AU - Motiwala Afaq AU - Rangasetty Umamahesh AU - Jneid Hani TI - Optimal Timing of Complete Revascularization in Patients With ST-Elevation Myocardial Infarction and Multivessel Disease: A Systematic Review and Meta-Analysis. T2 - The American journal of cardiology PY - 2026 AN - PMID:41812921 ER -
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.