In patients with ST-segment elevation myocardial infarction (STEMI) and multivessel coronary artery disease (MVD), the optimal timing for complete revascularization (CR) had not been clearly established. Previous studies showed that immediate CR was not inferior to deferred CR, although most deferred procedures were performed after hospital discharge. The question was whether outcomes differed between immediate CR and deferred CR performed during the same hospitalization.
This was a randomized, multicenter, open-label clinical trial that included 994 patients (with at least one significant lesion ≥50% in a non-culprit vessel ≥2.5 mm in diameter), assigned to either immediate complete revascularization (n=498) or deferred revascularization during hospitalization (n=496). Patients with cardiogenic shock, ≥50% unprotected left main disease, chronic total occlusions in non-culprit vessels, or a history of coronary artery bypass graft surgery were excluded.
In the results, immediate revascularization did not demonstrate non-inferiority compared with deferred revascularization. The primary endpoint (all-cause mortality, nonfatal myocardial infarction, or unplanned revascularization at 1 year) occurred in 10.0% vs 7.4% (HR 1.36; 95% CI 0.88–2.09; non-inferiority p=0.32). Mortality was 5% vs 3% (HR 1.65; 95% CI 0.83–3.27), showing a trend toward higher risk with the immediate strategy, although not statistically significant. Nonfatal myocardial infarction occurred in 3.6% vs 2.8% (HR 1.29; 95% CI 0.58–2.86) and unplanned revascularization in 2.8% vs 2.4% (HR 1.16; 95% CI 0.48–2.78), with no relevant differences. Overall, the immediate strategy showed a trend toward more events, particularly early deaths.
The authors concluded that, in patients with STEMI and multivessel disease, immediate complete revascularization was not non-inferior to deferred revascularization during hospitalization in terms of mortality, nonfatal myocardial infarction, or unplanned revascularization at one year.
Reference: Youngkeun Ahn et al. Presentado en Major Late Breaking Trials, ESC 2025, Madrid, España. Publicado en The Lancet, 31 de agosto de 2025.
