Complete revascularization in patients with acute myocardial infarction and multivessel disease: Pooled analysis of Kaplan-Meier-derived individual-patient-data - 03/12/25

Doi : 10.1016/j.ahj.2025.107284

Ahmed Abdelaziz, MD ^a,^b, Shrouk Ramadan, MD ^a,^c, Mohammed Tarek Hasan, MD ^a,^d, Muhammad Desouky, MD ^e, Karim Atta, MBBS ^a,^f, Abdelrahman Hafez, MD ^a,^d, Mahmoud Mohamed Shams, MD ^a,^g, Ahmed Helmi, MD ^a,^h, Rahma AbdElfattah Ibrahim, MD ^a,ⁱ, Ahmed Sobhy, MD ^a,ⁱ, Rehab Adel Diab, MD ^a,^d, Fayed Mohamed Rzk, MD ^a,^j, Ahmed Farid Gadelmawla, MD ^a,^j, Ziad Mohsen Alenna, MD ^a,ⁱ, Mohamed Abdelaziz, MD ^a,^d, Mohamed Nabil Hamouda, MD ^a,^k, Noha Hammad, MD ^a,^l, Daniel Lorenzatti, MD ^b, Carl J Lavie, MD ^m, Leandro Slipczuk, MD, PhD ^b, Gregg W Stone, MD ^n,^⁎

^a Medical Research Group of Egypt (MRGE), Negida Academy, Arlington, MA

^b Division of Cardiology, Montefiore Health System/Albert Einstein College of Medicine, Bronx, NY

^c Faculty of Medicine, Ain Shams University, Cairo, Egypt

^d Faculty of Medicine, Al-Azhar University, Cairo, Egypt

^e The Brooklyn Hospital Center, Brooklyn, NY

^f Institute of Medicine, National Research Mordovia State University, Saransk, Russia

^g Faculty of Medicine, Tanta University, Tanta, Egypt

^h Faculty of Medicine, Alexandria University, Alexandria, Egypt

ⁱ Faculty of Medicine, KafrElsheikh University. KafrElsheikh, Egypt

^j Faculty of medicine, Menofia university, Menofia, Egypt

^k Faculty of Medicine, Misr University for Science and Technology, Giza, Egypt

^l Faculty of Medicine, Port Said University, Port Said, Egypt

^m Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School-the UQ School of Medicine, New Orleans, LA

ⁿ Icahn School of Medicine at Mount Sinai, New York, NY

^⁎ Reprint requests: Gregg W Stone, MD, Mount Sinai Medical Center, 1 Gustave L. Levy Place, New York, NY 10029. Mount Sinai Medical Center 1 Gustave L. Levy Place New York NY 10029

Highlights

•	The present study incorporated data from 9 RCTs and 9,658 patients with time-to-first event data examining CR versus IR strategies in patients with acute MI and MVD.
•	CR reduced MACE by 41%, driven by an 18% reduction in CV mortality, a 31% reduction in MI, and a 38% reduction in unplanned repeat revascularizations.
•	The present study demonstrates, for the first time, significant reduction in all-cause mortality with CR by 36%.
•	Attention should now shift to the optimal approaches to safely achieving CR, including whether proceed with index-procedure CR or staged-procedure CR; whether to guide CR by angiography, physiology or intravascular imaging; and optimizing clinician training.
•	Future studies are warranted to determine whether patients with NSTEMI have improved survival with CR.

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ABSTRACT

Complete revascularization in patients with ST-segment elevation myocardial infarction (STEMI) and multivessel disease reduces major adverse cardiac events (MACE) compared with incomplete revascularization, although whether survival is improved is uncertain. For this systematic review and meta-analysis, all randomized trials of complete vs incomplete revascularization in patients with acute MI without cardiogenic shock were identified from PubMed, Scopus, Web of Science, and Cochrane Library databases from inception to December 31, 2024. The primary and major secondary endpoints were MACE and all-cause mortality derived from reconstructed time-to-event individual-patient-data from published Kaplan-Meier curves. Additional outcomes included cardiovascular mortality, MI, and unplanned repeat revascularizations. Outcomes were expressed as hazard ratios with 95% confidence intervals. This study was registered with the PROSPERO (number, CRD42023415428). A total of 9 randomized trials with 9,658 patients (86.8% with STEMI) were identified among whom 4,671 (48.4%) patients had complete revascularization. Patients with complete revascularization had a lower 5-year risk of MACE (HR: 0.59, 95% CI: 0.54 to 0.66, P < .001) compared with incomplete revascularization. Complete revascularization was also associated with lower 5-year risks of all-cause mortality (HR: 0.64, 95% CI: 0.56 to 0.72, P < .001), cardiovascular mortality (HR: 0.82, 95% CI: 0.71 to 0.95, P = .008), MI (HR: 0.69, 95% CI: 0.55 to 0.87, P < .001), and unplanned repeat revascularizations (HR: 0.62, 95% CI: 0.54 to 0.71, P < .001). Complete revascularization results in lower risks of all-cause and cardiovascular mortality, MI, unplanned repeat revascularizations and MACE in patients with acute MI and multivessel disease. These results support current guidelines recommending CR in hemodynamically stable patients with STEMI, emphasizing that this approach may improve survival.

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Article 107284- février 2026 Retour au numéro

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Complete revascularization in patients with acute myocardial infarction and multivessel disease: Pooled analysis of Kaplan-Meier-derived individual-patient-data - 03/12/25

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