- Question
- In patients with acute coronary syndrome and multivessel disease, should complete revascularisation by PCI be performed immediately during the index procedure or staged?
- Design
- Prospective, open-label, non-inferiority randomised trial (1:1) conducted at 29 hospitals in Belgium, Italy, the Netherlands and Spain. A total of 1525 patients were analysed by intention to treat, with 1-year follow-up.
- Population
- Patients aged 18 to 85 years with ST-segment elevation myocardial infarction or non-ST-segment elevation acute coronary syndrome, multivessel disease (vessels of at least 2.5 mm with ≥70% stenosis or positive physiology) and a clearly identifiable culprit lesion.
- Intervention
- Immediate complete revascularisation: PCI of the culprit lesion followed, during the same index procedure, by PCI of the non-culprit lesions deemed significant by the operator.
- Control
- Staged complete revascularisation: PCI of the culprit lesion only at the index procedure, with PCI of non-culprit lesions within 6 weeks afterwards.
- Primary outcome
- Composite of all-cause mortality, myocardial infarction, any unplanned ischaemia-driven revascularisation or cerebrovascular events at 1 year. Non-inferiority was defined by an upper bound of the 95% CI of the HR of 1.39.
- Results
- The primary outcome occurred in 57 patients (7.6%) with the immediate strategy and 71 (9.4%) with the staged strategy (HR 0.78; 95% CI 0.55-1.11; non-inferiority p=0.0011). Myocardial infarction was less frequent with the immediate strategy (1.9% vs 4.5%; HR 0.41; 95% CI 0.22-0.76).
- Safety
- All-cause death did not differ between groups (1.9% with immediate vs 1.2% with staged; HR 1.56; 95% CI 0.68-3.61). Unplanned ischaemia-driven revascularisations were less frequent with the immediate strategy (4.2% vs 6.7%; HR 0.61; 95% CI 0.39-0.95).
- Conclusion
- Immediate complete revascularisation was non-inferior to staged revascularisation for the primary composite outcome and was associated with fewer myocardial infarctions and fewer unplanned revascularisations.
- Why it matters
- The trial supported completing revascularisation during the index procedure in patients with acute coronary syndrome and multivessel disease, without the need to defer non-culprit lesions, simplifying care and avoiding a second procedure.
Card generated automatically with AI from the abstract of the original publication and the trial registry; every figure was checked against those sources. It may contain errors: verify the data at the source before using it for clinical decisions.
Generated on October 14, 2026