AIMS
In patients with stable coronary artery disease undergoing percutaneous coronary intervention (PCI), the optimal timing of complete revascularization remains uncertain. Revascularization may be performed during a single index procedure or as planned staged PCI, guided by lesion complexity, contrast use, and radiation exposure. Current guidelines offer no definitive recommendation, and available data are inconsistent. This meta-analysis evaluates hospital outcomes of immediate versus staged PCI in stable multivessel coronary artery disease.

METHODS AND RESULTS
A systemic literature search including PubMed and Cochrane was conducted to compare immediate versus staged multivessel PCI in stable coronary artery disease. The primary outcome was major adverse cardiovascular events analyzed using a fixed-effects Mantel-Haenszel model to compute pooled odds ratios. Three studies met inclusion criteria, including one randomized controlled trial and two prospective registry analyses with a total of 11,631 patients were analyzed. Of these, 3790 underwent immediate PCI while 7,823 underwent staged PCI. The pooled analysis demonstrated a significantly higher risk of adverse events in the immediate PCI group (OR 1.24 [95% Cl 1.06-1.45], p=0.007) with moderate heterogeneity (l2 = 49%). Subgroup examination indicated that the increased risk was most pronounced in patients undergoing complex PCI, particularly in unprotected left main disease.

CONCLUSIONS
In patients with stable coronary artery disease undergoing multivessel PCI, our results reinforced the importance of an anatomical risk-stratified approach toward multivessel intervention. A staged revascularization strategy was associated with lower rates of major adverse cardiovascular events compared with immediate multivessel PCI, particularly in anatomically complex disease. These findings support an individualized revascularization approach, whereby single-session PCI may be appropriate in selected patients with low lesion complexity, while a staged strategy should be considered in cases involving left main disease or high anatomical complexity.