The optimal timing for complete revascularisation in patients with ST-segment elevation myocardial infarction (STEMI) and multivessel coronary artery disease remains a topic of clinical debate.¹˒² The OPTION–STEMI trial aimed to determine whether an immediate complete revascularisation strategy was non-inferior to a staged approach performed during the same index hospital admission.¹

OPTION–STEMI was a multicentre, open-label, randomised, non-inferiority trial conducted across 14 hospitals in South Korea. The study enrolled 994 patients aged 19 years or older with STEMI and multivessel disease who had already undergone successful percutaneous coronary intervention (PCI) for the culprit lesion.

Participants were randomly assigned on a 1:1 basis to either immediate complete revascularisation, where PCI of non-culprit lesions was performed during the index procedure, or staged complete revascularisation, where non-culprit lesion PCI was performed on a different day but still within the index admission. The primary endpoint was a composite of death from any cause, non-fatal myocardial infarction, or any unplanned revascularisation at 1-year follow-up.

At 1 year, the primary endpoint occurred in 65 of 498 patients (13%) in the immediate revascularisation group compared to 53 of 496 patients (11%) in the staged revascularisation group (Hazard Ratio 1.24; 95% CI 0.86–1.79). The trial failed to meet its primary endpoint, as the result did not establish non-inferiority for the immediate approach (p_non-inferiority_=0.24).

Regarding safety, there were no significant differences between the two groups in the rates of stroke, major bleeding, or contrast-induced nephropathy. However, cardiogenic shock during the index hospitalisation was observed more frequently in the immediate revascularisation group, occurring in 18 patients (4%) versus nine patients (2%) in the staged group.

The investigators concluded that "among patients with STEMI and multivessel disease, immediate complete revascularisation was not shown to be non-inferior to staged complete revascularisation during the index admission in terms of incidence of a composite of death from any cause, non-fatal myocardial infarction, or any unplanned revascularisation at 1 year." They suggest this finding may help inform future clinical guidelines regarding the optimal strategy for these patients.

Long-term follow-up for the OPTION–STEMI trial is currently ongoing to assess outcomes beyond the initial 1-year period.

This study was funded by Boston Scientific.

References

1. Kim MC, Ahn JH, Hyun DY, et al. Immediate versus staged complete revascularisation during index admission in patients with ST-segment elevation myocardial infarction and multivessel disease (OPTION–STEMI): a multicentre, non-inferiority, open-label, randomised trial. Lancet. 2025. https://doi.org/10.1016/S0140-6736(25)01529-6

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. https://doi.org/10.1093/eurheartj/ehad191

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