Recent randomized trials and meta-analysis have suggested that multivessel PCI is associated with better outcomes, however, the option of multivessel PCI strategy is still unknown. 

Trials that randomized patients with STEMI and multivessel coronary artery disease to any combination of the three different revascularization strategies [immediate multivessel PCI, staged multivessel PCI, or culprit-only PCI] were included. Random effect risk ratio (RR) and 95% confidence interval (CI) were conducted. Network meta-analysis was constructed using mixed treatment comparison models, and the three revascularization strategies were compared.

A total of 13 trials with 7627 patients were included. In the pairwise meta-analysis, a multivessel PCI strategy (immediate or staged) was associated with a lower risk of major adverse cardiac events (MACE) (RR: 0.58; 95% CI: 0.45 to 0.74) compared with a culprit-only PCI strategy, which was mainly due to lower risks of myocardial infarction (RR: 0.67; 95% CI: 0.51 to 0.88) and revascularization (RR: 0.38; 95% CI: 0.28 to 0.51). There was also a trend toward a lower risk of all-cause death with a multivessel PCI strategy (RR: 0.85; 95% CI: 0.69 to 1.04). Safety outcomes including major bleeding, renal failure, and stroke were similar between a multivessel PCI strategy versus a culprit-only PCI strategy. The reduction in the risk of MACE, myocardial infarction, and revascularization was observed irrespective of the strategy of multivessel PCI in the mixed treatment model.

For patients with multivessel coronary artery disease undergoing primary PCI, multivessel PCI at an immediate or staged procedure was associated with a reduction of MACE due to reductions in myocardial infarction and revascularization, yet the risk of all-cause death was not different among the three revascularization strategies.