One-time versus staged multivessel percutaneous coronary intervention in patients with non-ST-segment elevation acute coronary syndrome: a systematic review and meta-analysis

Abstract

Introduction The optimal revascularization strategy for patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS) and multivessel disease remains uncertain. This meta-analysis aimed to evaluate the impact of one-time versus staged multivessel percutaneous coronary intervention (PCI) on clinical outcomes. Material and methods PubMed, Embase, and the Cochrane Library were searched for randomized controlled trials and cohort studies comparing one-time and staged PCI in NSTE-ACS patients with multivessel disease from January 1, 2000 to June 4, 2026. Study quality was assessed, data were extracted independently by two reviewers, and pooled risk ratios (RRs) with 95% confidence intervals (CIs) were calculated using R software and the meta package. Results Ten studies involving 6,749 patients (4,235 one-time PCI; 2,514 staged PCI) were included. In randomized trials, one-time PCI significantly reduced repeat revascularization (RR = 0.71, 95% CI 0.51–0.98, p = 0.037) versus staged PCI, with no differences in mortality or recurrent myocardial infarction. Cohort studies and the pooled analysis showed no significant differences across outcomes. Conclusions For NSTE-ACS patients with multivessel disease, multivessel revascularization in a single procedure may reduce repeat revascularization compared with staged PCI, but the evidence remains limited.