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In this pre-specified analysis, patients were stratified according to the presence of renal dysfunction at baseline, defined at an estimated glomerular filtration rate (eGFR) of 60\u00a0ml\/min\/1.73 m\n                      <jats:sup>2<\/jats:sup>\n                      . Patients with an eGFR\u2009&lt;\u200930\u00a0ml\/min\/1.73 m\n                      <jats:sup>2<\/jats:sup>\n                      were excluded from the trial. The primary endpoint was a composite of death, non-fatal myocardial infarction, stroke, unplanned revascularization, or hospitalization for heart failure at 1\u00a0year.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      In MULTISTARS AMI, 108 (13%) of 832 patients had renal dysfunction. The primary endpoint occurred more frequently in patients with renal dysfunction (19.4% vs. 11.2%, unadjusted HR 1.82, 95% CI 1.13\u20132.94), primarily driven by higher rates of death. Among patients with renal dysfunction, the rates of the primary end point were 14.5% and 24.5% in the immediate and staged PCI groups (unadjusted HR 0.55, 95% CI 0.23\u20131.33). There was no interaction between renal dysfunction and the randomized treatment assignment with respect to the primary end point (adjusted HR 1.30, 95% CI 0.8\u20132.20, p\n                      <jats:sub>int<\/jats:sub>\n                      0.82). The occurrence of acute renal insufficiency was statistically similar in patients with renal dysfunction who underwent immediate and staged PCI (10.9% vs. 18.9%, unadjusted HR 0.61, 95% CI 0.22\u20131.72, p\n                      <jats:sub>int<\/jats:sub>\n                      0.09). Renal dysfunction at baseline emerged as a strong risk factor for the development of acute renal insufficiency (adjusted HR 5.0, 95% CI 2.30\u201310.70,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.01).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Outcomes with immediate compared to staged multivessel PCI did not appear significantly altered by the presence of renal dysfunction\u00a0at baseline. (Supported by Boston Scientific; MULTISTARS AMI ClinicalTrials.gov number, NCT03135275).<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00392-026-02875-w","type":"journal-article","created":{"date-parts":[[2026,3,9]],"date-time":"2026-03-09T07:55:54Z","timestamp":1773042954000},"page":"1831-1844","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Impact of renal dysfunction on immediate versus staged revascularization of non-culprit lesions in patients with ST segment elevation myocardial infarction: a pre-specified subgroup analysis of the randomized MULTISTARS AMI 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Felix did not report conflicts of interest with respect to the submitted work.Moritz Seiffert reports personal fees and non-financial support from Abbott Vascular, personal fees from Abiomed, personal fees from AstraZeneca, grants, personal fees and non-financial support from Boston Scientific, personal fees from Bristol-Myers Squibb, personal fees and non-financial support from Edwards Lifesciences, grants and personal fees from Philips, personal fees from Medtronic, personal fees from Amgen, personal fees from Shockwave Medical, personal fees from Daichii Sankyo, personal fees from Pfizer, personal fees from Siemens Healthineers, and personal fees from Inari Medical, outside the submitted work.Rahel Kesterke did not report conflicts of interest with respect to the submitted work.Peter Nordbeck did not report conflicts of interest with respect to the submitted work.Bernhard Witzenbichler did not report conflicts of interest with respect to the submitted work.Irene M. Lang has relationships with drug companies including AOP-Health, Actelion-Janssen, MSD, United Therapeutics, Pulnovo, Medtronic, Neutrolis and Sanofi. In addition to being investigator in trials involving these companies, relationships include consultancy service, research grants, and membership of scientific advisory boards.Mirjam Kessler did not report conflicts of interest with respect to the submitted work.Christian Valina did not report conflicts of interest with respect to the submitted work.Alban Dibra did not report conflicts of interest with respect to the submitted work.Philipp Jakob did not report conflicts of interest with respect to the submitted work.Marco Moccetti did not report conflicts of interest with respect to the submitted work.Matteo Vercellino did not report conflicts of interest with respect to the submitted work.Luise Gaede reports consultant\/lecture fees for Abiomed, Astra Zeneca, Abbott vascular, Boston Scientific, Edwards Lifesciences, SMT, and Shock Wave.Lorenz Bott-Fl\u00fcgel did not report conflicts of interest with respect to the submitted work.Julia Stehli did not report conflicts of interest with respect to the submitted work.Alessandro Candreva did not report conflicts of interest with respect to the submitted work.Francesco Paneni has received advisory fees from Novo Nordisk, all outside of the submitted work.Christian Templin did not report conflicts of interest with respect to the submitted work.Matthias Schindler did not report conflicts of interest with respect to the submitted work.Manfred Wischnewsky did not report conflicts of interest with respect to the submitted work.Greca Zanda did not report conflicts of interest with respect to the submitted work.Giorgio Quadri did not report conflicts of interest with respect to the submitted work.Norman Mangner received a research and an educational grant from Abiomed to his institution, outside the submitted work; an educational grant from BostonScientific to his institution, outside the submitted work; received personal fees from Abbott, Abiomed, Amgen, AstraZeneca, B. Braun, Biotronik, Boston Scientific, Edwards Lifesciences, Inari, Medtronic, Pfizer\/BMS, and Shockwave, outside the submitted work.Aurel Toma did not report conflicts of interest with respect to the submitted work.Giulia Magnani did not report conflicts of interest with respect to the submitted work.Peter Clemmensen reports previous or current involvement in research contracts, consulting, speakers bureau or received research and educational grants from: Abbott, Abiomed, AliveCor Inc. AstraZeneca, Aventis, Bayer, Boehringer Ingelheim, Bristol Myers Squibb, CeleCor, Daiichi Sankyo, Eli-Lilly, Evolva, Fibrex, Idorsia, IQVIA, Janssen, Merck, Myogen, Medtronic, Mitsubishi Pharma, The Medicines Company, Nycomed, Organon, Pfizer, Pharmacia, Philips, Regado, Sanofi, Searle, Servier, and ViFor Pharma.Thomas F. L\u00fcscher does no longer accept any honoraria from industry but has received.research and educational grants. Professor L\u00fcscher has outside this work received research and educational grants to the institution from Abbott, Amgen, AstraZeneca, Bayer, Boehringer Ingelheim, Daiichi Sankyo, Eli Lilly, Novartis, Novo Nordisk, Roche Diagnostics, Sanofi, and Vifor.Thomas M\u00fcnzel did not report conflicts of interest with respect to the submitted work.Christian Schulze did not report conflicts of interest with respect to the submitted work.Karl-Ludwig Laugwitz did not report conflicts of interest with respect to the submitted work.Wolfgang Rottbauer did not report conflicts of interest with respect to the submitted work.Franz-Josef Neumann reports the following potential conflicts of interest: Novartis: DSMB. Meril: Consultancy fees, DSMB. Daichi-Sankyo: Speaker honoraria. Amgen: Speaker honoraria.Steffen Schneider did not report conflicts of interest with respect to the submitted work.Thomas Riemer did not report conflicts of interest with respect to the submitted work.Franz Weidinger did not report conflicts of interest with respect to the submitted work.Stephan Achenbach did not report conflicts of interest with respect to the submitted work.Gert Richardt did not report conflicts of interest with respect to the submitted work.Adnan Kastrati did not report conflicts of interest with respect to the submitted work.Ian Ford did not report conflicts of interest with respect to the submitted work.Frank Ruschitzka has not received personal payments by pharmaceutical companies or device manufacturers in the last 3\u00a0years (remuneration for the time spent in activities, such as participation as steering committee member of clinical trials and member of the Pfizer Research Award selection committee in Switzerland, were made directly to the University of Zurich). The Department of Cardiology (University Hospital of Zurich\/University of Zurich) reports research-, educational- and\/or travel grants from Abbott, Abiomed, Alnylam, Amarin, Amgen, Astra Zeneca, At the Limits Ltd., Bayer, Biotronik, BMS, Boehringer Ingelheim, Boston Scientific, Bracco, CM Microport, Concept Medical, CTI, Daiichi Sankyo, Davos Congress, Edwards Lifesciences, FomF GmbH, Hamilton Health Sciences, Holcim, IHF, Innosuisse, IumiraDX, Kantar, LabPoint, MedAlliance, Medcon International, Medical Education Global Solutions, Medtronic, MicroPort, Monocle, Novartis, Novo Nordisk, OM Pharma, Pfizer, Quintiles Switzerland Sarl, RecorMedical, Roche Diagnostics, Roche Pharma, Sahajanand IN, Sanofi, Sarstedt AG, Servier, Sorin SRM SAS, SSS Int., Terumo Deutschland, Trama Solutions, V- Wave, Vifor, and ZOLL. These grants do not impact on Prof. Ruschitzka`s personal remuneration.Barbara E. St\u00e4hli is supported by the H.H. Sheikh Khalifa bin Hamad Al-Thani Research Programme, and has received research grants to the institution from Boston Scientific, the B. Braun Foundation, the German Center for Cardiovascular Research (DZHK), the German Heart Research Foundation, Edwards Lifesciences, the Iten-Kohaut Foundation, and the OPO Foundation. B. S. has received consulting and speaker fees from Abbott Vascular, Abiomed, and Boston Scientific.","order":1,"name":"Ethics","label":"Conflict of interests","group":{"name":"EthicsHeading","label":"Declarations"}}]}}