Physiology-guided vs Angiography-guided Non-culprit Lesion Complete Revascularization for Acute MI & Multivessel Disease (COMPLETE-2)

June 16, 2025 updated by: Population Health Research Institute

A Randomized Trial of Physiology-guided vs Angiography-guided Non-culprit Lesion Complete Revascularization Strategies & an Observational Study of Optical Coherence Tomography in Patients With Acute MI & Multivessel Coronary Artery Disease

COMPLETE-2 is a prospective, multi-centre, randomized controlled trial comparing a strategy of physiology-guided complete revascularization to angiography-guided complete revascularization in patients with acute ST-segment elevation myocardial infarction (STEMI) or non-ST-segment elevation myocardial infarction (NSTEMI) and multivessel coronary artery disease (CAD) who have undergone successful culprit lesion Percutaneous Coronary Intervention (PCI).

COMPLETE-2 OCT is a large scale, prospective, multi-centre, observational, imaging study of patients with STEMI or NSTEMI and multivessel CAD in a subset of eligible COMPLETE-2 patients.

Study Overview

Detailed Description

COMPLETE-2 STUDY OBJECTIVES

  1. To determine whether a strategy of physiology-guided complete revascularization is non-inferior to a strategy of angiography-guided complete revascularization on the efficacy composite outcome of cardiovascular (CV) death, new myocardial infarction (MI) or ischemia-driven revascularization (IDR).
  2. To determine whether a physiology-guided complete revascularization strategy is superior to an angiography-guided complete revascularization strategy in reducing the safety composite outcome of clinically significant bleeding, stroke, stent thrombosis or contrast-associated acute kidney injury.

Study Type

Interventional

Enrollment (Estimated)

5100

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Contact

Study Locations

    • New South Wales
      • Westmead, New South Wales, Australia
        • Recruiting
        • Westmead Hospital
        • Principal Investigator:
          • Sarah Zaman, MD
      • Vienna, Austria
        • Recruiting
        • Klinik Floridsdorf
        • Principal Investigator:
          • Andreas Schober, MD
      • Brampton, Canada
        • Recruiting
        • William Osler Health System
        • Principal Investigator:
          • Shy Amlani, MD
      • Edmonton, Canada
        • Recruiting
        • University of Alberta Hospital, Mazankowski Heart
        • Principal Investigator:
          • Robert Welsh, MD
      • Hamilton, Canada
        • Recruiting
        • Hamilton Health Sciences
        • Principal Investigator:
          • Matthew Sibbald, MD
      • Kingston, Canada
        • Recruiting
        • Kingston Health Sciences Centre
        • Principal Investigator:
          • Wael Abuzeid, MD
      • Kitchener, Canada
        • Recruiting
        • St. Mary's General Hospital
        • Principal Investigator:
          • Hahn Hoe Kim, MD
      • London, Canada
        • Recruiting
        • London Health Sciences Centre
        • Principal Investigator:
          • Shahar Lavi, MD
      • Montréal, Canada
        • Recruiting
        • Centre Hospitalier de l'Universite de Montreal
        • Principal Investigator:
          • Samer Masour, MD
      • Montréal, Canada
        • Recruiting
        • Hopital du Sacre-Coeur de Montreal
        • Principal Investigator:
          • Erick Schampaert, MD
      • Newmarket, Canada
        • Recruiting
        • Southlake Regional Health Centre
        • Principal Investigator:
          • Warren Cantor, MD
      • Nova Scotia, Canada
        • Recruiting
        • Nova Scotia Health
        • Principal Investigator:
          • Lawrence Title, MD
      • Ottawa, Canada
        • Recruiting
        • University of Ottawa Heart Institute
        • Principal Investigator:
          • Derek So, MD
      • Québec, Canada
        • Recruiting
        • Institut Universitaire De Cardiologie Et De Pneumologie De Québec
        • Principal Investigator:
          • Tomas Cieza, MD
      • Regina, Canada
        • Recruiting
        • Regina General Hospital
        • Principal Investigator:
          • Payam Dehghani, MD
      • Saskatoon, Canada
        • Recruiting
        • Royal University Hospital
        • Principal Investigator:
          • Jay Shavadia, MD
      • St. Catharines, Canada
        • Recruiting
        • Niagara Health
        • Principal Investigator:
          • Natalia Pinilla, MD
      • St. John's, Canada
        • Recruiting
        • Newfoundland and Labrador Health Services
        • Principal Investigator:
          • Allison Hall, MD
      • Thunder Bay, Canada
        • Recruiting
        • Thunder Bay Regional Health Sciences Centre
        • Principal Investigator:
          • Alexandra Bastiany, MD
      • Toronto, Canada
        • Recruiting
        • Sunnybrook Health Sciences Centre
        • Principal Investigator:
          • Mina Madan, MD
      • Toronto, Canada
        • Recruiting
        • St. Michael's Hospital (Unity Health Toronto)
        • Principal Investigator:
          • Akshay Bagai, MD
      • Trois-Rivières, Canada
        • Recruiting
        • Ciusss McQ - Chaur
        • Principal Investigator:
          • Vincent Spagnoli, MD
      • Vancouver, Canada
        • Recruiting
        • Vancouver General Hospital
        • Principal Investigator:
          • David Wood, MD
      • Vancouver, Canada
        • Recruiting
        • St Paul's Hospital
        • Principal Investigator:
          • Robert Boone, MD
      • Winnipeg, Canada
        • Recruiting
        • St. Boniface Hospital
        • Principal Investigator:
          • Kunal Minhas, MD
    • Quebec
      • Montréal, Quebec, Canada, H4A 3J1
        • Recruiting
        • McGill University Health Centre (MUHC)
        • Principal Investigator:
          • Elie Akl, MD
      • Brno, Czechia
        • Recruiting
        • St. Anne's University Hospital
        • Principal Investigator:
          • Ota Hlinomaz, MD
      • Aalborg, Denmark
        • Recruiting
        • Aalborg University Hospital
        • Principal Investigator:
          • Ashkan Eftekhari, MD
      • Aarhus, Denmark
        • Recruiting
        • Aarhus University Hospital
        • Principal Investigator:
          • Evald Hoj Christiansen, MD
      • Copenhagen, Denmark
        • Recruiting
        • Rigshospitalet - Copenhagen University Hospital
        • Principal Investigator:
          • Thomas Engstrom, MD
      • Helsinki, Finland
        • Recruiting
        • Helsinki University Hospital
        • Principal Investigator:
          • Pasi Karjalainen, MD
      • Tampere, Finland
        • Recruiting
        • Tays sydankeskus oy
        • Principal Investigator:
          • Olli Kajander, MD
      • Turku, Finland
        • Recruiting
        • Turku University Hospital
        • Principal Investigator:
          • Samuli Jaakkola, MD
      • Cologne, Germany
        • Recruiting
        • St. Vinzenz-Hospital
        • Principal Investigator:
          • Jan-Malte Sinning, MD
      • Dachau, Germany
        • Recruiting
        • Helios Amper-Klinikum
        • Principal Investigator:
          • Bernhard Witzenbichler, MD
      • Frankfurt, Germany
        • Recruiting
        • Universitätsklinikum Frankfurt
        • Principal Investigator:
          • David Leistner, MD
      • Hamburg, Germany
        • Recruiting
        • Marienkrankenhaus
        • Principal Investigator:
          • Edith Lubos, MD
      • Hamburg, Germany
        • Recruiting
        • University Heart & Vascular Center Hamburg
        • Principal Investigator:
          • Fabian Brunner, MD
      • Hamburg, Germany
        • Recruiting
        • Schoen Klink Hamburg
        • Principal Investigator:
          • Frank Hennersdorf, MD
      • Heide, Germany
        • Recruiting
        • WKK Heide
        • Principal Investigator:
          • Patrick Diemert, MD
      • Budapest, Hungary
        • Recruiting
        • Gottsegen National Cardiovascular Center
        • Principal Investigator:
          • Zsolt Piroth, MD
      • Szeged, Hungary
        • Recruiting
        • University of Szeged
        • Principal Investigator:
          • Zoltan Ruzsa, MD
      • Hyderabad, India
        • Recruiting
        • Medicover Hospitals
        • Principal Investigator:
          • Sharath Reddy Annam, MD
      • Secunderabad, India
        • Recruiting
        • Krishna Institute of Medical Sciences
        • Principal Investigator:
          • Ajay Jagannath Swamy, MD
    • Kerala
      • Ernakulam, Kerala, India
        • Recruiting
        • Lisie Hospital
        • Principal Investigator:
          • Rony Matthew, MD
      • Kollam, Kerala, India
        • Recruiting
        • Meditrina Hospital
        • Principal Investigator:
          • Prathap Kumar, MD
      • Kottayam, Kerala, India
        • Recruiting
        • Caritas Hospital Trust
        • Principal Investigator:
          • Deepak Davidson, MD
    • Madhya Pradesh
      • Indore, Madhya Pradesh, India
        • Recruiting
        • Apollo Rajshree Hospitals
        • Principal Investigator:
          • Sarita Rao, MD
    • Rajasthan
      • Jaipur, Rajasthan, India
        • Recruiting
        • Rukmani Birla Hospital
        • Principal Investigator:
          • Sanjeeb Roy, MD
    • Tamil Nadu
      • Chennai, Tamil Nadu, India
        • Recruiting
        • Apollo Hospital
        • Principal Investigator:
          • Sengottuvelu Gunasekaran, MD
      • Chennai, Tamil Nadu, India
        • Recruiting
        • The Madras Medical Mission
        • Principal Investigator:
          • Ajit Mullasari, MD
      • Madurai, Tamil Nadu, India
        • Recruiting
        • Meenakshi Mission Hospital and Research Center
        • Principal Investigator:
          • Selvamani Sethuraman, MD
      • Arezzo, Italy
        • Recruiting
        • Azienda Usl Toscana sud est
        • Principal Investigator:
          • Kenneth Ducci, MD
      • Bologna, Italy
        • Recruiting
        • UOC Cardiologia - Ospedale Maggiore
        • Principal Investigator:
          • Gianni Casella, MD
      • Ferrara, Italy
        • Recruiting
        • Azienda Ospedaliero - Universitaria di Ferrara
        • Principal Investigator:
          • Gianluca Campo, MD
      • Grosseto, Italy
        • Recruiting
        • Misericordia Hospital
        • Principal Investigator:
          • Andrea Picchi, MD
      • Reggio Emilia, Italy
        • Recruiting
        • Azienda USL-IRCCS di Reggio Emilia, Reggio
        • Principal Investigator:
          • Vincenzo Guiducci, MD
      • Rome, Italy
        • Recruiting
        • Sant Andrea Hospital - Sapienza University
        • Principal Investigator:
          • Emanuele Barbato, MD
      • Oslo, Norway
        • Recruiting
        • Oslo University Hospital Ullevål
        • Principal Investigator:
          • Trygve Sundby Hall, MD
      • Stavanger, Norway
        • Recruiting
        • Stavanger University Hospital
        • Principal Investigator:
          • Alf Inge Larsen, MD
      • Tromso, Norway
        • Recruiting
        • University Hospital Tromso
        • Principal Investigator:
          • Andreas Kristensen, MD
    • Arendal
      • Kristiansand, Arendal, Norway
        • Recruiting
        • Sorlandet Hospital Arendal
        • Principal Investigator:
          • Slobodan Calic, MD
    • Dolnoslaskie
      • Legnica, Dolnoslaskie, Poland
        • Recruiting
        • Provincial Specialized Hospital
        • Principal Investigator:
          • Piotr Rola, MD
      • Lubin, Dolnoslaskie, Poland
        • Recruiting
        • Miedziowym Centrum Zdrowia S.A. w Lubinie
        • Principal Investigator:
          • Adrian Wlodarczak, MD
    • Mazowieckie
      • Warsaw, Mazowieckie, Poland
        • Recruiting
        • Medical University of Warsaw
        • Principal Investigator:
          • Lukasz Koltowski, MD
      • Belgrade, Serbia
        • Recruiting
        • University Clinical Center of Serbia
        • Principal Investigator:
          • Goran Stankovic, MD
      • Belgrade, Serbia
        • Recruiting
        • Institute for Cardiovascular diseases Dedinje
        • Principal Investigator:
          • Dragan Topic, MD
      • Madrid, Spain
        • Recruiting
        • Hospital Universitario La Paz
        • Principal Investigator:
          • Raul Moreno Gomez, MD
      • Madrid, Spain
        • Recruiting
        • Hospital Clinico San Carlos
        • Principal Investigator:
          • Nieves Gonzalo, MD
      • Madrid, Spain
        • Recruiting
        • Hospital Ramon y Cajal
        • Principal Investigator:
          • Ana Pardo, MD
      • Madrid, Spain
        • Recruiting
        • Hospital Universitario de la Princesa
        • Principal Investigator:
          • Fernando Alfonso Manterola, MD
      • Seville, Spain
        • Recruiting
        • Hospital Virgen del Rocío
        • Principal Investigator:
          • Jose Francisco Diaz Fernandez, MD
      • Valencia, Spain
        • Recruiting
        • Hospital Universitari i Politecnic La Fe
        • Principal Investigator:
          • Jose Luis Diez, MD
      • Valladolid, Spain
        • Recruiting
        • Hospital Clinico Universitario de Valladolid
        • Principal Investigator:
          • Ignacio J Amat Santos, MD
      • Huddinge, Sweden
        • Recruiting
        • Karolinska University Hospital
        • Principal Investigator:
          • Juliane Jurga, MD
      • Jonkoping,, Sweden
        • Recruiting
        • Länssjukhuset Ryhov
        • Principal Investigator:
          • Neshro Barmano, MD
      • Karlstad, Sweden
        • Recruiting
        • Karlstad Central Hospital
        • Principal Investigator:
          • Payam Khalili, MD
      • Lund, Sweden
        • Recruiting
        • Skane University Hospital
        • Principal Investigator:
          • David Erlinge, MD
      • Stockholm, Sweden
        • Recruiting
        • Danderyd Hospital
        • Principal Investigator:
          • Felix Bohm, MD
      • Umeå, Sweden
        • Recruiting
        • Umea University Hospital
        • Principal Investigator:
          • Jonas Andersson, MD
      • Uppsala, Sweden
        • Recruiting
        • Uppsala University Hospital
        • Principal Investigator:
          • Kasper Andersen, MD
      • Ashford, United Kingdom
        • Recruiting
        • East Kent Hospitals University NHS Foundation Trust
        • Principal Investigator:
          • Rajiv Rampat, MD
      • Blackpool, United Kingdom
        • Recruiting
        • Blackpool Teaching Hospitals
        • Principal Investigator:
          • Gavin Galasko, MD
      • Dundee, United Kingdom
        • Recruiting
        • Ninewells Hospital
        • Principal Investigator:
          • John Irving, MD
      • Harefield, United Kingdom
        • Recruiting
        • Harefield Hospital
        • Principal Investigator:
          • Mohammed Akhtar, MD
      • Kettering, United Kingdom
        • Recruiting
        • Kettering General Hospital
        • Principal Investigator:
          • Simon Hetherington, MD
      • Leicester, United Kingdom
        • Recruiting
        • University Hospitals of Leicester
        • Principal Investigator:
          • Andrew Ladwiniec, MD
      • Liverpool, United Kingdom
        • Recruiting
        • Liverpool Heart and Chest Hospital
        • Principal Investigator:
          • Joel Giblett, MD
      • London, United Kingdom
        • Recruiting
        • Imperial College Healthcare NHS Trust
        • Principal Investigator:
          • Sukhjinder Nijjer, MD
      • London, United Kingdom
        • Recruiting
        • Barts Health NHS Trust
        • Principal Investigator:
          • Dan Jones, MD
      • London, United Kingdom
        • Recruiting
        • Royal Free London NHS Foundation Trust
        • Principal Investigator:
          • Sundeep Kalra, MD
      • Manchester, United Kingdom
        • Recruiting
        • Manchester University NHS Foundation Trust
        • Principal Investigator:
          • Jaydeep Sarma, MD
      • Middlesbrough, United Kingdom
        • Recruiting
        • The James Cook University Hospital
        • Principal Investigator:
          • David Austin, MD
      • Newcastle upon Tyne, United Kingdom
        • Recruiting
        • Freeman Hospital
        • Principal Investigator:
          • Mohammad Alkhalil, MD
      • Reading, United Kingdom
        • Recruiting
        • Royal Berkshire Foundation NHS Trust
        • Principal Investigator:
          • Neil Ruparelia, MD
      • Sheffield, United Kingdom
        • Recruiting
        • Sheffield Teaching Hospitals
        • Principal Investigator:
          • James Richardson, MD
      • Stevenage, United Kingdom
        • Recruiting
        • East and North Hertfordshire NHS Trust
        • Principal Investigator:
          • Manivannan Srinivasan, MD
      • Truro, United Kingdom
        • Recruiting
        • Royal Cornwall Hospitals NHS Trust
        • Principal Investigator:
          • Sen Devadathan, MD
      • Wolverhampton, United Kingdom
        • Recruiting
        • The Royal Wolverhampton NHS Trust
        • Principal Investigator:
          • Benjamin Wrigley, MD
      • Worcester, United Kingdom
        • Recruiting
        • Worcestershire Acute Hospitals NHS Trust
        • Principal Investigator:
          • Helen Routledge, MD
    • California
      • Los Angeles, California, United States, 90095
        • Recruiting
        • UCLA
        • Principal Investigator:
          • Rushi Parikh, MD
      • San Francisco, California, United States, 94143
        • Recruiting
        • University of California, San Francisco
        • Principal Investigator:
          • Krishan Soni, MD
    • Kansas
      • Wichita, Kansas, United States, 67226
        • Recruiting
        • Cardiovascular Research Institute of Kansas
        • Principal Investigator:
          • Bassem Chehab, MD
    • Maryland
      • Baltimore, Maryland, United States, 21205
        • Recruiting
        • The Johns Hopkins University School of Medicine
        • Principal Investigator:
          • Peter Johnston, MD
    • Michigan
      • Ann Arbor, Michigan, United States, 48109
        • Recruiting
        • University of Michigan
        • Principal Investigator:
          • Brett Wanamaker, MD
    • Minnesota
      • Coon Rapids, Minnesota, United States, 55433
        • Recruiting
        • Metropolitan Cardiology Consultants / Metropolitan Heart and Vascular Institute (MCC/MHVI)
        • Principal Investigator:
          • Matthew Whitebeck, MD
    • New Jersey
      • Jersey City, New Jersey, United States, 07302
        • Recruiting
        • RWJ Barnabas Health
        • Principal Investigator:
          • Kimberly Skelding, MD
    • New York
      • Bronx, New York, United States, 10467
        • Recruiting
        • Montefiore Medical Center
        • Principal Investigator:
          • Mark Menegus, MD
      • Cooperstown, New York, United States, 13326
        • Recruiting
        • Bassett Medical Center
        • Principal Investigator:
          • Dhananjai Menzies, MD
      • New York, New York, United States, 10010
        • Recruiting
        • VA New York Harbor Healthcare System
        • Principal Investigator:
          • Binita Shah, MD
      • New York, New York, United States, 10016
        • Recruiting
        • NYU Grossman School of Medicine
        • Principal Investigator:
          • Sripal Bangalore, MD
    • Ohio
      • Cleveland, Ohio, United States, 44195
        • Recruiting
        • Cleveland Clinic
        • Principal Investigator:
          • Jacqueline Tamis-Holland, MD
    • Virginia
      • Charlottesville, Virginia, United States, 22903
        • Recruiting
        • University of Virginia Medical Center
        • Principal Investigator:
          • Michael Ragosta, MD

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

18 years and older (Adult, Older Adult)

Accepts Healthy Volunteers

No

Description

Inclusion Criteria:

  1. Patients presenting with STEMI or type 1 NSTEMI and within 72 hours of successful culprit-lesion PCI
  2. Residual coronary artery disease defined as at least 1 additional non-infarct-related coronary artery stenosis that meets all of the following criteria:

    1. Amenable to successful treatment with PCI
    2. At least 50% diameter stenosis by visual estimation
    3. At least 2.5 mm in diameter
  3. Planned complete revascularization strategy for qualifying MI

Exclusion Criteria:

  1. Planned or prior coronary artery bypass graft (CABG) surgery
  2. Inability to clearly identify a culprit lesion for STEMI or NSTEMI based on angiographic appearance and/or ECG changes and/or regional wall motion abnormalities
  3. Prior PCI of a non-culprit lesion in a different vessel from the culprit lesion within 45 days of randomization
  4. Planned medical treatment of all qualifying non-culprit lesions (i.e., no PCI)
  5. Presence of severe non-culprit-lesion stenosis with reduced epicardial flow (TIMI flow ≤ 2) or >90% visual diameter stenosis
  6. Presence of a chronic total occlusion (CTO) if it is the only qualifying non-culprit lesion (patients with a CTO plus additional qualifying non-culprit lesions are eligible)
  7. The only qualifying non-culprit lesion is in the same vessel territory as the culprit lesion
  8. Baseline STEMI or NSTEMI was due to a suspected non-atherothrombotic mechanism such as type 2 MI (supply-demand mismatch), including spontaneous coronary artery dissection or coronary artery embolism
  9. Non-cardiovascular co-morbidity with expected life expectancy <2 years
  10. Any other medical, geographic, or social factor making study participation impractical or precluding 5 year follow-up

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Treatment
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: Single

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Active Comparator: Physiology-guided Non-Culprit-Lesion (NCL) PCI
Patients randomized to this group will have their physiology assessment using RFR and/or FFR of all qualifying NCLs that were identified prior to randomization. Other validated non-hyperemic physiology ratios (eg. iFR) may only be used when RFR is not available.
For RFR, PCI will be performed as per local practice for all lesions with RFR ≤0.89. For FFR, PCI will be performed as per local practice for all NCLs with FFR ≤0.80.
Other: Angiography-guided NCL PCI
Patients randomized to this group will undergo routine staged PCI of all qualifying NCLs that were identified prior to randomization.
PCI will be performed as per local practice

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Time Frame
Efficacy: Time to first occurrence of the composite of CV death, new MI, or IDR
Time Frame: at study completion, a minimum of 2 years
at study completion, a minimum of 2 years
Safety: Time to first occurrence of the composite of clinically significant bleeding, stroke, stent thrombosis, or contrast-associated acute kidney injury.
Time Frame: at study completion, a minimum of 2 years
at study completion, a minimum of 2 years

Secondary Outcome Measures

Outcome Measure
Time Frame
Time to first occurrence of the composite of CV death or new MI.
Time Frame: at study completion, a minimum of 2 years
at study completion, a minimum of 2 years
Net clinical outcome: Time to first occurrence of the composite of CV death, new MI, clinically significant bleeding, stroke, stent thrombosis or contrast-associated acute kidney injury.
Time Frame: at study completion, a minimum of 2 years
at study completion, a minimum of 2 years

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Investigators

  • Principal Investigator: Shamir Mehta, MD, Population Health Research Institute

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

June 22, 2023

Primary Completion (Estimated)

June 1, 2028

Study Completion (Estimated)

June 1, 2028

Study Registration Dates

First Submitted

January 17, 2023

First Submitted That Met QC Criteria

January 25, 2023

First Posted (Actual)

January 27, 2023

Study Record Updates

Last Update Posted (Actual)

June 19, 2025

Last Update Submitted That Met QC Criteria

June 16, 2025

Last Verified

June 1, 2025

More Information

Terms related to this study

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

product manufactured in and exported from the U.S.

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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