{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,9]],"date-time":"2026-01-09T15:01:26Z","timestamp":1767970886758,"version":"3.49.0"},"reference-count":19,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2022,6,21]],"date-time":"2022-06-21T00:00:00Z","timestamp":1655769600000},"content-version":"unspecified","delay-in-days":20,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Open Heart"],"accepted":{"date-parts":[[2022,5,17]]},"published-print":{"date-parts":[[2022,6]]},"abstract":"<jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Several studies have demonstrated that complete revascularisation improves clinical outcomes in patients with ST-segment elevation myocardial infarction (STEMI) and multivessel coronary disease. However, the optimal timing of non-culprit lesion revascularisation remains controversial.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>The aim of this systematic review and meta-analysis was to assess the effect of timing of complete revascularisation on cardiovascular outcomes in patients with STEMI and multivessel coronary artery disease.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Searches of PubMed, the Cochrane Library, ClinicalTrials.gov and the reference lists of relevant papers were conducted covering the period from 2004 to 2019. A pairwise analysis was performed to compare the difference in clinical outcome between early complete revascularisation (index procedure or index hospitalisation) and delayed complete revascularisation (after discharge) in patients with STEMI.<\/jats:p>\n                  <jats:p>The primary endpoint was the incidence of major adverse cardiac events (MACE), which was defined as the composite of all-cause mortality, recurrent myocardial infarction, unplanned repeated revascularisation and cardiovascular death.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Twelve studies including a total of 7596 patients were identified. The MACE rate was 10.37% in early complete revascularisation compared with 18.17% in culprit only (p=0.01). When complete revascularisation was delayed, the MACE rate was 11.81% after complete revascularisation compared with 17.21% in culprit-only percutaneous coronary intervention (PCI) (p=0.01). A meta-regression analysis demonstrated no relationship between timing of complete revascularisation and reduction in MACE relative to culprit-only PCI (p=0.862).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>In patients with STEMI treated by primary PCI and multivessel disease, there is a benefit of complete revascularisation over culprit-only PCI whether non-culprit revascularisation is performed early in hospital or delayed as an elective procedure. We have not demonstrated a relationship between timing of complete revascularisation and MACE.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>PROSPERO registration number<\/jats:title>\n                  <jats:p>CRD42021226789.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/openhrt-2022-001975","type":"journal-article","created":{"date-parts":[[2022,6,21]],"date-time":"2022-06-21T11:20:47Z","timestamp":1655810447000},"page":"e001975","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["Early versus delayed complete revascularisation in patients presenting with ST-segment elevation myocardial infarction and multivessel disease: a systematic review and meta-analysis of randomised controlled trials"],"prefix":"10.1136","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3919-9873","authenticated-orcid":false,"given":"Khaled","family":"Abouelmagd","sequence":"first","affiliation":[{"name":"Cardiology Department, Al-Azhar University, New Damietta, Egypt"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hesham","family":"Tayel","sequence":"additional","affiliation":[{"name":"Cardiology Department, Menoufia University, Shebin El-Kom, Egypt"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ashraf","family":"Atta","sequence":"additional","affiliation":[{"name":"Cardiology Department, Minia University, El Minia, Egypt"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrew","family":"Ladwiniec","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Sciences, University of Leicester, Leicester, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mokhtar","family":"Ibrahim","sequence":"additional","affiliation":[{"name":"Cardiology Department, University Hospitals of Leicester NHS Trust, Leicester, UK"},{"name":"Cardiology Department, Ain Shams University, Cairo, Egypt"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2022,6,21]]},"reference":[{"key":"2025081710025352000_9.1.e001975.1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehm184"},{"key":"2025081710025352000_9.1.e001975.2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM200009283431303"},{"key":"2025081710025352000_9.1.e001975.3","doi-asserted-by":"crossref","DOI":"10.1161\/JAHA.119.015263","article-title":"Complete revascularization by percutaneous coronary intervention for patients with ST-segment-elevation myocardial infarction and multivessel coronary artery disease: an updated meta-analysis of randomized trials","volume":"9","author":"Ahmad","year":"2020","journal-title":"J Am Heart Assoc"},{"key":"2025081710025352000_9.1.e001975.4","first-page":"356","article-title":"Optimal timing of staged percutaneous coronary intervention in ST-segment elevation myocardial infarction patients with multivessel disease","volume":"15","author":"Zhao","year":"2018","journal-title":"J Geriatr Cardiol"},{"key":"2025081710025352000_9.1.e001975.5","doi-asserted-by":"publisher","DOI":"10.7326\/M14-2385"},{"key":"2025081710025352000_9.1.e001975.6","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.l4898"},{"key":"2025081710025352000_9.1.e001975.7","doi-asserted-by":"crossref","first-page":"1411","DOI":"10.1056\/NEJMoa1907775","article-title":"Complete revascularization with multivessel PCI for myocardial infarction","volume":"381","author":"Mehta","year":"2019","journal-title":"N Engl J Med"},{"key":"2025081710025352000_9.1.e001975.8","doi-asserted-by":"crossref","first-page":"844","DOI":"10.1016\/j.ijcard.2016.11.186","article-title":"Complete revascularization versus culprit-only revascularization in ST-segment elevation myocardial infarction and multivessel disease patients undergoing primary percutaneous coronary intervention: a meta-analysis and trial sequential analysis","volume":"228","author":"Wang","year":"2017","journal-title":"Int J Cardiol"},{"key":"2025081710025352000_9.1.e001975.9","doi-asserted-by":"crossref","first-page":"1234","DOI":"10.1056\/NEJMoa1701067","article-title":"Fractional flow reserve-guided multivessel angioplasty in myocardial infarction","volume":"376","author":"Smits","year":"2017","journal-title":"N Engl J Med"},{"key":"2025081710025352000_9.1.e001975.10","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(15)60648-1"},{"key":"2025081710025352000_9.1.e001975.11","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1111\/joic.12293","article-title":"A randomized trial of complete versus Culprit-Only revascularization during primary percutaneous coronary intervention in diabetic patients with acute ST elevation myocardial infarction and multi vessel disease","volume":"29","author":"Hamza","year":"2016","journal-title":"J Interv Cardiol"},{"key":"2025081710025352000_9.1.e001975.12","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2014.12.038"},{"key":"2025081710025352000_9.1.e001975.13","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1305520"},{"key":"2025081710025352000_9.1.e001975.14","doi-asserted-by":"publisher","DOI":"10.1080\/14628840310030441"},{"key":"2025081710025352000_9.1.e001975.15","first-page":"14","article-title":"[Effect of the terms of complete revascularization on the outcomes of treatment of patients with st segment elevation myocardial infarction and multivessel coronary artery disease]","volume":"19","author":"Tarasov","year":"2013","journal-title":"Angiol Sosud Khir"},{"key":"2025081710025352000_9.1.e001975.16","doi-asserted-by":"publisher","DOI":"10.3760\/cma.j.issn.2095-4352.2015.03.003"},{"key":"2025081710025352000_9.1.e001975.17","unstructured":"Hlinomaz O . Multivessel coronary disease diagnosed at the time of primary PCI for STEMI: complete revascularization versus conservative strategy: the Prague 13 trial. Available: http:\/\/sbhci.org.br\/wp-content\/uploads\/2015\/05\/PRAGUE-13-Trial.pdf"},{"key":"2025081710025352000_9.1.e001975.18","doi-asserted-by":"publisher","DOI":"10.4244\/EIJV5I8A162"},{"key":"2025081710025352000_9.1.e001975.19","doi-asserted-by":"publisher","DOI":"10.1136\/hrt.2009.177162"}],"container-title":["Open Heart"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/openhrt-2022-001975","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,17]],"date-time":"2025-08-17T17:03:01Z","timestamp":1755450181000},"score":1,"resource":{"primary":{"URL":"https:\/\/openheart.bmj.com\/lookup\/doi\/10.1136\/openhrt-2022-001975"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,6]]},"references-count":19,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2022,6,21]]},"published-print":{"date-parts":[[2022,6]]}},"alternative-id":["10.1136\/openhrt-2022-001975"],"URL":"https:\/\/doi.org\/10.1136\/openhrt-2022-001975","relation":{},"ISSN":["2053-3624"],"issn-type":[{"value":"2053-3624","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,6]]}}}