To evaluate the perioperative safety of complete revascularization (MV-PCI) and partial revascularization (CV-PCI) in patients with acute coronary syndrome and multivessel disease.

Randomized controlled trials of different revascularization methods to prevent acute coronary syndrome were searched in databases including Pubmed, Embase, Cochrane Collaboration, CNKI, Wanfang Data, and VIP database. High-quality articles that met the requirements and the relevant data from the articles obtained were then screened and analyzed. RevMan5.3 software was used to evaluate the efficacy of different revascularization methods for the treatment of coronary multivessel disease with regard to average hospitalization days, time to opening of infarct-related vessel, contrast agent dosage, average contrast time, platelet glycoprotein IIb/IIIa receptor antagonist use, mean stent number, and intra-aortic balloon pump use.

A total of 18 articles were included, involving 119 674 patients with MV-ACS. Meta-analysis showed that compared with CV-PCI, MV-PCI significantly reduced perioperative mean hospital stay (MD=-4.27, 95%CI: -5.1~-3.44, P<0.00001), and increased the number of stents used by patients (MD=0.98, 95%CI: 0.88~1.09, P<0.00001), contrast agent usage (MD=72.99, 95%CI: 33.24~112.73, P=0.0003), and contrast time (MD=7.27, 95%CI: 2.2~12.35, P=0.005), but vascular access time (MD=-0.64, 95%CI: -1.69~-0.41, P=0.24), the incidence of radiographic contrast nephropathy (relative risk [RR]=0.99, 95%CI: 0.51~1.92, P=0.98), perioperative bleeding events (RR=1.11, 95%CI: 0.84~1.46, P=0.48), and intra-aortic balloon pump use rate (RR=1.02, 95%CI: 0.83~1.24, P=0.88) had no significant change.

MV-PCI can reduce perioperative vascular access time and mean hospitalization days in patients with MV-ACS, although the amount of contrast agent, contrast time, and average number of stents are increased, while the incidence of radiographic contrast nephropathy, perioperative bleeding events, and cardiogenic shock does not increase.