Immediate vs. Staged Complete Revascularisation in STEMI Patients: New Insights from the OPTION-STEMI Trial

Strategic Insights -

The European Society of Cardiology (ESC) issued a press release highlighting the results of the OPTION-STEMI trial, which investigated the timing of complete revascularisation in patients with ST-segment elevation myocardial infarction (STEMI) and multivessel coronary artery disease. The trial found that immediate complete revascularisation was not noninferior to staged complete revascularisation during index hospitalisation, suggesting that immediate revascularisation may be associated with worse outcomes in patients with signs of heart failure.

Key Takeaways:

  • The ESC Guidelines recommend complete revascularisation for patients with STEMI and multivessel coronary artery disease, but the timing of the non-culprit lesion treatment is not well-defined.
  • The OPTION-STEMI trial compared immediate complete revascularisation with PCI for the culprit and non-culprit lesions during the same procedure to staged complete revascularisation, where PCI for non-culprit lesions took place on another day during the same hospitalisation.
  • Noninferiority was not demonstrated between immediate and staged complete revascularisation, with a signal for worse outcomes with immediate complete revascularisation in patients with signs of heart failure.
  • Prespecified subgroup analyses suggested heterogeneity in the treatment effect according to the Killip class, with immediate complete revascularisation being associated with more harm in patients with signs of heart failure (Killip class ëÑII: HR 1.79; 95% CI 1.05 to 3.05).
  • The trial was supported by Boston Scientific, and the Principal Investigator, Professor Youngkeun Ahn, reported research grants from various pharmaceutical companies and funding from the Korean Society of Cardiometabolic Syndrome.

Statistics:

  • 994 patients underwent randomisation in the OPTION-STEMI trial, with 79% of patients being men and a median age of 66 years.
  • 33% of patients presented with Killip class II or III, indicating signs of heart failure.
  • The median length of hospital stay was 4 days in the immediate group and 5 days in the staged group.
  • At 1 year, the primary endpoint of death, MI, and any unplanned revascularisation occurred in 13.1% of patients in the immediate group and 10.8% in the staged group (hazard ratio [HR] 1.24; 95% CI 0.86 to 1.79; p for noninferiority=0.24).

Sources:

[1]'OPTION-STEMI: Timing of complete revascularization during index hospitalization in patients with STEMI and multivessel disease' presented during HOT LINE 6 on 31 August 2025 at 09:27 to 09:37 in Madrid (Main Auditorium).

[2] Byrne RA, Rossello X, Coughlan JJ, et al. 2023 ESC Guidelines for the management of acute coronary syndromes. Eur Heart J. 2023;44:3720--3826.

[3] Diletti R, den Dekker WK, Bennett J, et al. Immediate versus staged complete revascularisation in patients presenting with acute coronary syndrome and multivessel coronary disease (BIOVASC): a prospective, open-label, non-inferiority, randomised trial. Lancet. 2023;401:1172--1182.

[4] StÈñhli BE, Varbella F, Linke A, et al. Timing of complete revascularization with multivessel PCI for myocardial infarction. N Engl J Med. 2023;389:1368--1379.