Complete revascularization reduces cardiovascular mortality in patients with acute myocardial infarction and multivessel coronary disease

Myocardial revascularization in patients with acute myocardial infarction (AMI) and multivessel coronary artery disease remains a topic of ongoing debate, particularly regarding the benefit of treating only the culprit lesion versus performing complete revascularization. Previous clinical trials suggested a reduction in nonfatal events with a complete approach, but uncertainty persisted regarding its effect on cardiovascular and all-cause mortality. 

An individual patient data (IPD) meta-analysis of six randomized clinical trials, including a total of 8,836 participants, compared complete revascularization versus culprit-lesion-only intervention in patients with AMI and multivessel disease. The primary endpoints were the composite of cardiovascular death or new myocardial infarction and cardiovascular death alone. 

The mean age of participants was 66 years, and 24% were women. Approximately 88% presented with STEMI and 12% with NSTEMI. After a median follow-up of 38 months, the composite endpoint of cardiovascular death or new myocardial infarction occurred in 9.0% of patients in the complete revascularization group versus 11.5% in the culprit-only group (HR 0.76; 95% CI 0.67–0.87; p<0.001). Cardiovascular death alone was reduced from 4.6% to 3.6% (HR 0.76; 95% CI 0.62–0.93; p=0.009). 

All-cause mortality was also lower with complete revascularization (7.2% vs. 8.1%; HR 0.85; 95% CI 0.73–0.99; p=0.04), while non-cardiovascular death did not differ between groups. In addition, there was a significant reduction in new myocardial infarction (HR 0.76; 95% CI 0.65–0.90; p=0.001). 

These findings provide the most robust evidence to date that complete revascularization in patients with AMI and multivessel disease improves key cardiovascular outcomes and reduces mortality, supporting its adoption as the preferred strategy when feasible and safe. 

Editorial note: This content was developed with the support of artificial intelligence technologies for optimizing writing and information structure. All material was carefully reviewed, validated, and complemented by human specialists prior to publication to ensure scientific accuracy and adherence to best editorial practices. 

References:  

1. Mehta SR, et al. An individual patient data meta-analysis of complete versus culprit-lesion only revascularization for acute myocardial infarction involving >8,800 individuals. Presented at the American Heart Association Scientific Sessions 2025.