Optimal Timing of Complete Revascularization in Acute Coronary Syndrome: A Systematic Review and Meta-Analysis

Background: studies have suggested that complete revascularization is superior to culprit-only revascularization for the treatment of enzyme-positive acute coronary syndrome. however,the optimal timing of complete revascularization remains unclear. we conducted a systematic review and meta-analysis of randomized controlled trials comparing single-stage complete revascularization with multistage percutaneous coronary intervention in patients with st-segment elevation myocardial infarction or non-st-segment elevation myocardial infarction with multivessel disease.methods and results: we systematically searched the cochrane central register of controlled trials,embase,pubmed,and medline for randomized controlled trials comparing single-stage complete revascularization with multistage revascularization in patients with enzyme-positive acute coronary syndrome. the primary outcome was the incidence of major adverse cardiovascular events at longest follow-up. data were pooled using dersimonian and laird random-effects models. four randomized controlled trials (n=838) were included in our meta-analysis. the risk of unplanned repeat revascularization at longest follow-up was significantly lower in patients randomized to single-stage complete revascularization (risk ratio,0.68; 95% ci,0.47-0.99). results also suggest a trend towards lower risks of major adverse cardiovascular events for patients randomized to single-stage revascularization at 6 months (risk ratio,0.67; 95% ci,0.40-1.11) and at longest follow-up (risk ratio,0.79; 95% ci,0.52-1.20). risks of mortality and recurrent myocardial infarction at longest follow-up were also lower with single-stage revascularization,but 95% cis were wide and included unity.conclusions: our results suggest that single-stage complete revascularization is safe. there also appears to be a trend towards lower long-term risks of mortality and major adverse cardiovascular events; however,additional randomized controlled trials are required to confirm the potential benefits of single-stage multivessel percutaneous coronary intervention. © 2017 the authors. published on behalf of the american heart association,inc.,by wiley.