Complete versus culprit-only revascularisation in patients with st-elevation myocardial infarction and multivessel coronary artery disease: A systematic review and meta-analysis

Abstract Background and Aims ST-elevation myocardial infarction (STEMI) remains a leading cause of morbidity and mortality worldwide. Approximately 40–65% of patients present with multivessel coronary artery disease, which is associated with poorer clinical outcomes. While primary percutaneous coronary intervention (PCI) has traditionally focused on the culprit lesion, emerging evidence suggests that complete revascularisation may provide additional benefit. This study aimed to compare the outcomes of complete versus culprit-only revascularisation. Methods A systematic review and random-effects meta-analysis were conducted using PubMed, Scopus, ProQuest, and ScienceDirect databases up to 2025. Randomised and observational studies involving patients with STEMI and multivessel disease were included. Studies comparing complete versus culprit-only PCI were analysed, with major adverse cardiovascular events (MACE) as the primary outcome. Results Eight high-quality studies involving approximately 22,000 patients were included. Complete revascularisation significantly reduced MACE by 30% compared with culprit-only PCI (RR 0.70, 95% CI 0.61–0.80; p<0.0001). Substantial heterogeneity was observed (I²=86%), likely reflecting differences in revascularisation timing and patient risk profiles. However, the direction of effect consistently favoured complete revascularisation across studies. Conclusion Complete revascularisation significantly improves clinical outcomes in patients with STEMI and multivessel coronary artery disease. Despite heterogeneity, the evidence consistently supports its superiority over culprit-only PCI, reinforcing current guideline recommendations and its role as the preferred strategy to improve long-term prognosis.