Introduction:

The optimal timing of revascularization in non-ST-segment elevation myocardial infarction (NSTEMI) with multivessel disease (MVD) remains controversial.

Aim:

We investigated the impact of different revascularization strategies on clinical outcomes to assess the optimal revascularization strategy for these patients.

Methods:

We performed a network meta-analysis of cohort studies comparing revascularization strategies in NSTEMI with MVD. Effect sizes were calculated as odds ratios (ORs) using a random-effects model. The primary efficacy outcome was all-cause mortality and the primary safety outcome was recurrent myocardial infarction.

Results:

Eight eligible studies involving 34,151 patients receiving four revascularization strategies were analyzed. Compared to conventional culprit-only revascularization (COR), planned complete multi-vessel percutaneous coronary intervention during a second hospitalization (MV-PCI) reduced the risk of major adverse cardiovascular events (MACEs) (MV-PCI vs. COR: OR = 0.53; 95% CI: 0.38–0.74) and decreased all-cause mortality (MV-PCI vs. COR: OR = 0.53; 95% CI: 0.30–0.93) and the likelihood of repeat revascularization (MV-PCI vs. COR: OR = 0.55; 95% CI: 0.37–0.82). However, compared to COR, immediate complete revascularization (ICR) but not MV-PCI was associated with reduced risk of recurrent MI (COR vs. ICR: OR = 1.39; 95% CI: 1.07–1.81; MV-PCI vs. COR: OR = 0.64; 95% CI: 0.40–1.01). Compared to MV-PCI: COR and staged complete revascularization during index PCI (SCR) increased the risk of cardiovascular mortality (MV-PCI vs. COR: OR = 0.48; 95% CI: 0.34–0.70; MV-PCI vs. SCR: OR = 0.62; 95% CI: 0.40–0.96). COR also had significantly higher cardiovascular mortality compared to ICR (COR vs. ICR: OR = 1.38; 95% CI: 1.02–1.85).

Conclusions:

Complete revascularization is more effective compared to culprit-only revascularization for most follow-ups.