Complete Revascularization (CR) Versus Culprit-Only Percutaneous Coronary Intervention (CO-PCI) in NSTE-ACS with Multivessel Disease: A Systematic Review and Meta-Analysis.

Objective: Contemporary data have demonstrated that a complete revascularization (CR) strategy reduces adverse cardiovascular events compared with culprit vessel only-Percutaneous Coronary Intervention (CO-PCI) in ST Elevation Myocardial Infarction (STEMI). The optimal strategy of CR versus CO-PCI in Non-ST-Elevation Acute Coronary Syndrome (NSTE-ACS) remains unclear and was the goal of this meta-analysis.

Methods: A systematic search of PubMed, Embase, and Cochrane databases for English-language studies from inception till November 2024 comparing CR versus CO-PCI in NSTE-ACS patients with multi-vessel disease was performed. A meta-analysis was performed using a random-effects model to calculate the risk ratio (RR) and 95% confidence interval (CI). Primary outcomes were all-cause mortality and myocardial reinfarction.

Results: Eleven studies with total 36,997 NSTE-ACS patients were included in study with mean follow up of 31.3 months. CR showed reduction in all-cause mortality (1,457 of 16,939) compared to CO-PCI (2126 of 16,939) (RR: 0.66; 95% CI: 0.55 to 0.79). Myocardial reinfarction occurred in 149 of 6404 in CR versus 248 of 6404 in CO-PCI group (RR:0.57; 95% CI: 0.43 to 0.76). Composite endpoint was noted in 299 of 2,129 patients from CR vs 418 of 2131 patients from CO- PCI (RR:0.72; 95% CI: 0.63 to 0.82). Repeat revascularization was noted in 504 of 5661 patients from CR versus 849 of 5663 in CO- PCI patients group (RR:0.60; 95% CI: 0.54 to 0.66).

Conclusions: In NSTEMI and multivessel disease, CR reduces all-cause mortality, recurrent myocardial infarction, composite outcome, and repeat revascularization compared to CO-PCI.