- Question
- In patients with ST-segment elevation myocardial infarction and multivessel coronary disease, when should nonculprit lesions be revascularized: immediately or in a staged fashion?
- Design
- International, randomized, open-label, noninferiority trial conducted at 37 sites in Europe; 418 patients were assigned to the immediate group and 422 to the staged group.
- Population
- Hemodynamically stable patients with STEMI and multivessel coronary artery disease.
- Intervention
- Immediate multivessel PCI: treatment of the culprit and nonculprit lesions during the index procedure.
- Control
- PCI of the culprit lesion followed by staged multivessel PCI of nonculprit lesions 19 to 45 days after the index procedure.
- Primary outcome
- Composite of death from any cause, nonfatal myocardial infarction, stroke, unplanned ischemia-driven revascularization, or hospitalization for heart failure at 1 year after randomization.
- Results
- The primary end point occurred in 35 patients (8.5%) in the immediate group versus 68 (16.3%) in the staged group (risk ratio 0.52; 95% CI 0.38 to 0.72; P<0.001 for both noninferiority and superiority). Nonfatal myocardial infarction was 2.0% versus 5.3% and unplanned ischemia-driven revascularization 4.1% versus 9.3%.
- Safety
- A serious adverse event occurred in 104 patients in the immediate group and 145 in the staged group; the risks of death, stroke and heart failure hospitalization appeared similar in the two groups.
- Conclusion
- In stable patients with STEMI and multivessel disease, immediate multivessel PCI was noninferior to staged PCI at 1 year, with a lower frequency of the composite end point.
- Why it matters
- It provided randomized evidence supporting complete revascularization during the index procedure as an alternative to deferring it, which may avoid a repeat admission and 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