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Review
. 2023 Aug 23;15(8):e43968.
doi: 10.7759/cureus.43968. eCollection 2023 Aug.

Comparison of Immediate Versus Staged Complete Revascularisation in Patients Presenting With Acute Coronary Syndrome and Multivessel Disease: A Meta-Analysis of Randomized and Non-randomized Studies

Anurag Rawat  1 , Sumreen Nazly  2 , Jasvant Kumar  3 , Tayyaba J Khan  4 , Komal Kaur  5 , Gurvir Kaur  5   6 , Saima Batool  7 , Areeba Khan  8
Affiliations
Review

Comparison of Immediate Versus Staged Complete Revascularisation in Patients Presenting With Acute Coronary Syndrome and Multivessel Disease: A Meta-Analysis of Randomized and Non-randomized Studies

Anurag Rawat et al. Cureus. .

Abstract

Acute myocardial infarction is a critical medical condition that poses a significant health burden, leading to substantial morbidity. Despite advancements in medical care, managing this condition is challenging for patients and society. The preferred approach appears to be comprehensive multivessel revascularization, yet the optimal timing remains uncertain. This study aims to compare immediate complete revascularisation and stage complete vascularization in patients presenting with acute coronary syndrome (ACS) and multivessel coronary artery disease (MVD). The Preferred Reporting of Systematic Reviews and Meta-analysis (PRISMA) guidelines conducted the present meta-analysis. A comprehensive literature search was conducted using online databases, including PubMed, and EMBASE from 2010 onwards, to identify articles that compared cardiovascular outcomes between patients undergoing immediate and staged complete revascularization. We also searched Google Scholar for additional studies relevant to the present meta-analysis. The primary outcome assessed in this study was major adverse cardiovascular events (MACE). Secondary outcomes included all-cause mortality, cardiovascular mortality, myocardial infarction (MI), and revascularization. A total of 15 studies fulfilled pre-defined eligibility criteria and were included in the final analysis. Our analysis shows that staged revascularization is associated with improved outcomes in patients with ACS and multivessel CAD, including all-cause mortality and cardiovascular mortality, without increasing the risk of major adverse cardiovascular events, myocardial infarction, and the need for unplanned revascularization.

Keywords: acute coronary syndrome; immediate vascularization; multivessel disease; staged vascularization; systematic review and meta-analysis.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. PRISMA flowchart of study selection
Figure 2
Figure 2. Risk of bias assessment of RCTs
Figure 3
Figure 3. MACE
Sources: References [11-13, 15, 17-20, 23-24]
Figure 4
Figure 4. All-cause Mortality
Sources: References [11-24]
Figure 5
Figure 5. Cardiovascular Mortality
Sources: References [11, 13, 16-18, 23-25]
Figure 6
Figure 6. Myocardial Infarction
Sources: References [11-13, 15-20, 24-25]
Figure 7
Figure 7. Revascularization
Sources: References [11-17, 19-20, 24-25]
See this image and copyright information in PMC

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