This study compares two treatment strategies in patients with ST-elevation myocardial infarction (STEMI) and multivessel coronary artery disease (MVD) undergoing a pharmaco-invasive approach after successful fibrinolysis. The study evaluates whether one-time complete revascularization, in which the culprit and significant non-culprit lesions are treated during the same percutaneous coronary intervention (PCI) session, is better than a staged strategy, in which non-culprit lesions are treated in a separate percutaneous coronary intervention (PCI) procedure within 1 month.

The hypothesis is that one-time complete revascularization may reduce hospitalization time, cost, and recurrent ischemic symptoms without increasing short-term complications.

Participants are adults with acute ST-elevation myocardial infarction (STEMI) and multivessel coronary artery disease (MVD) who had successful fibrinolysis followed by coronary angiography and percutaneous coronary intervention (PCI). Outcomes include total hospitalization time, total expenses, contrast-induced nephropathy (CIN) within 72 hours, and major adverse cardiovascular events (MACE) during 3 months of follow-up.

Inclusion Criteria:

• Adults older than 18 years.
• Acute ST-elevation myocardial infarction treated with a pharmaco-invasive strategy.
• Successful fibrinolysis followed by coronary angiography and percutaneous coronary intervention.
• Multivessel coronary artery disease.
• Ability to provide written informed consent.

Exclusion Criteria:

• Primary percutaneous coronary intervention.
• Unsuccessful fibrinolysis requiring rescue percutaneous coronary intervention.
• Candidacy for coronary artery bypass grafting after angiography.
• Failed complete revascularization.
• Cardiogenic shock.
• Single-vessel coronary artery disease treated with a pharmaco-invasive strategy.
• Stent thrombosis.
• Chronic total occlusion.
• Planned percutaneous transluminal coronary angioplasty to a non-culprit lesion in a vessel smaller than 2.5 millimeters with more than 70 percent stenosis.
• Severe valvular heart disease.
• Pregnancy.
• Prior cardiac surgery.
• Congenital heart disease.
• Severe hepatic impairment.
• Severe renal impairment.

De-identified individual participant data underlying the results reported in this study will be made available to qualified researchers. Shared data may include baseline demographic and clinical characteristics, procedural data, laboratory results, echocardiographic findings, hospitalization data, and follow-up outcome data used in the published analyses. All shared data will be fully de-identified to protect participant privacy.

Data will be available beginning 6 months after publication of the study results and will remain available for 5 years.

Access will be provided to qualified researchers for scientifically sound research purposes after submission and approval of a methodologically appropriate proposal. Requests should include the study objectives, analysis plan, and intended use of the data. Data sharing will require approval by the principal investigator and institution, and may require a signed data use agreement.

This was an open-label study. Participants, care providers, and investigators were aware of treatment assignment because the timing and extent of revascularization differed by protocol. No formal masking of outcome assessment was specified.