Complete Revascularization Superior to Culprit-Lesion-Only PCI in Reducing Risk of CV Death, New MI in STEMI Patients

Complete revascularization was superior to culprit-lesion-only PCI at a median follow-up of three years in reducing the risk of cardiovascular death or new myocardial infarction (MI) in patients with STEMI and multivessel coronary artery disease, based on findings from the COMPLETE study presented Sept. 1 at ESC Congress 2019 and published in the New England Journal of Medicine.

Shamir Mehta, MD, FACC, and colleagues randomly assigned patients with STEMI and multivessel coronary artery disease who had undergone successful culprit-lesion PCI to a strategy of either complete revascularization with PCI of angiographically significant nonculprit lesions (n=2,016) or no further revascularization (n=2,025). Primary outcomes included the composite of cardiovascular death or MI, as well as the composite of cardiovascular death, MI or ischemia-driven revascularization.

At three years, cardiovascular death or MI had occurred in 7.8 percent of patients in the complete-revascularization group, compared with 10.5 percent in the culprit-lesion-only PCI group. Cardiovascular death, MI or ischemia-driven revascularization occurred in 8.9 percent in the complete-revascularization group as compared with 16.7 percent in the culprit-lesion-only PCI group.

Researchers did caution about several trial limitations, including that nonculprit-lesion PCI performed during the same procedure as that for the index culprit-lesion PCI for STEMI was not evaluated. Additionally, while cardiogenic shock was not an exclusion criterion, no patients with cardiogenic shock were enrolled in the trial. However, based on the trial results, they note that "for both primary outcomes, the benefit of complete revascularization was consistently observed regardless of the intended timing of nonculprit-lesion PCI."

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Clinical Topics: Invasive Cardiovascular Angiography and Intervention, Interventions and Imaging, Angiography, Nuclear Imaging

Keywords: ESC 19, ESC Congress, Myocardial Infarction, Percutaneous Coronary Intervention, Angiography


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