The optimal timing of complete revascularization in stable multivessel coronary artery disease (CAD) remains uncertain, particularly in patients with complex coronary anatomy. A meta-analysis presented at the EuroPCR 2026 compared outcomes between immediate and staged percutaneous coronary intervention (PCI) strategies in patients undergoing multivessel PCI for stable CAD.

The analysis included studies identified through systematic searches of PubMed and the Cochrane Library. Major adverse cardiovascular events (MACE) served as the primary endpoint, with pooled odds ratios calculated using a fixed-effects Mantel-Haenszel model. Three studies, including 1 randomized controlled trial and 2 prospective registry analyses, contributed data from 11,631 patients.

Findings

• Among 11,631 patients, 3,790 underwent immediate PCI and 7,823 underwent staged PCI.
• Immediate PCI was associated with a higher risk of MACE compared with staged PCI (odds ratio [OR] 1.24; 95% confidence interval [CI] 1.06-1.45; P = 0.007).
• Moderate heterogeneity was observed across studies (I² = 49%).
• The excess risk associated with immediate PCI appeared most pronounced in patients undergoing complex PCI, particularly those with unprotected left main coronary artery disease.

Staged multivessel PCI was associated with lower rates of adverse cardiovascular events compared with immediate PCI in stable CAD. The findings support an individualized, anatomy-guided approach to revascularization timing, particularly in patients with complex coronary disease.