Complete Revascularization with Multivessel PCI for Myocardial Infarction
Shamir R Mehta, David A Wood, Robert F Storey, Roxana Mehran, Kevin R Bainey, Helen Nguyen, Brandi Meeks, Giuseppe Di Pasquale, Jose López-Sendón, David P Faxon, Laura Mauri, Sunil V Rao, Laurent Feldman, P Gabriel Steg, Álvaro Avezum, Tej Sheth, Natalia Pinilla-Echeverri, Raul Moreno, Gianluca Campo, Benjamin Wrigley, Sasko Kedev, Andrew Sutton, Richard Oliver, Josep Rodés-Cabau, Goran Stanković, Robert Welsh, Shahar Lavi, Warren J Cantor, Jia Wang, Juliet Nakamya, Shrikant I Bangdiwala, John A Cairns, COMPLETE Trial Steering Committee and Investigators, John Amerena, Chin Hiew, Stephen Duffy, Dion Stub, Ahmad Farshid, Melanie Freeman, Chris Zeitz, Irene M Lang, Lorenz Koller, Antoine Guedes, Suzanne Pourbaix, Paulo Caramori, Jose de Ribamar Costa Jr, José Francisco Kerr Saraiva, Adrian Kormann, Frederico Ultramari, J Antonio Marin-Neto, André A Schmidt, José C Nicolau, Remo H M Furtado, Márcio Santos, Michael B Tsang, Nicholas Valettas, James L Velianou, Chris Beck, Sadia Nauman, David A Wood, Warren J Cantor, Kim Robbins, Vladimír Džavík, Shahar Lavi, Robert C Welsh, Warren Ball, Kapil Bhagirath, Robert Boone, Asim N Cheema, Khrystyna Kushniriuk, Eric A Cohen, Payam Dehghani, Anthony Della Siega, Kushal Dighe, John Ducas, Saleem A Kassam, Hahn-Hoe Kim, André Kokis, S Najaf Nadeem, Michel Nguyen, Jean-Philippe Pelletier, Josep Rodés-Cabou, Erick Schampaert, Philippe Genereux, Bruce Sussex, Robert Teskey, Mouhieddin Traboulsi, Tycho Vuurmans, Brian Wong, Yuan Wu, Xiao-Shu Cheng, Qiang Fu, Wang Qingsheng, Jia Shaobin, Wei Wu, Ma Yitong, Yin Yuehui, Qun Zheng, Boris Vesga, Ota Hlinomaz, Erkki Ilveskoski, Olli Kajander, Laurent Feldman, Philippe Gabriel Steg, Jean Guillaume Dillinger, Olivier Dubreuil, Emile Ferrari, Olivier Nallet, Olivier Varenne, Thomas Schmitz, Alexander Wolf, Georgios Hahalis, Vassilis Voudris, John Tsorlalis, Antonios Ziakas, Iván Horváth, Zsolt Kőszegi, Zsuzsa Tokár, Shmuel Fuchs, Michael Kapeliovich, Giuseppe Di Pasquale, Elisa Filippini, Gianluca Campo, Simone Biscaglia, Fabrizio D'Ascenzo, Claudio Moretti, Vincenzo Guiducci, Gianluca Pignatelli, Reggio Emilia, Ferdinando Varbella, Giorgio Quadri, Darar A Al Khdair, Khaled Almerri, Vytautas Abraitis, Taida Ivanauskiene, Sasko Kedev, Darko Kitanoski, Juan Carlos Perez Alva, Bogdan Januś, Artur Baszko, Hélder Pereira, Fausto J Pinto, Pedro Carrilho Ferreira, Maria Dorobantu, Lucian Calmac, Noor Alkamel, Hani Altaradi, Mohammed A Alshehri, Mohammed A Anwar, Goran Stanković, Zlatko Mehmedbegovic, Mpiko Ntsekhe, Shaheen Pandie, Pravin Manga, Raul Moreno, Guillermo Galeote, Pablo Avanzas, Cesar Moris, Francisco Fernández Aviles, Antonio Fernandez Ortiz, José Ramón González Juanatey, Jose Seijas Amigo, Andrés Iñiguez, Victor Jiménez, Iñigo Lozano, Josepa Mauri Ferré, Ignacio Sánchez Pérez, Giovanna Sarno, Robert Kastberg, Florim Cuculi, Habib Haouala, Dhaker Lahidheb, Robert F Storey, James D Richardson, Sami Firoozi, Pitt Lim, Konrad Grosser, Jonathan Hill, Neville Kukreja, Vijay Kunadian, Louise Quinn, Joseph Mills, David E Newby, Philip D Adamson, Richard M Oliver, Alisdair Ryding, Jaydeep Sarma, Michael D Seddon, Dan McKenzie, Joanne Shannon, Andrew Sutton, Robin van Lingen, Sue Webber, Benjamin Wrigley, Salman Arain, Richard Bach, Sripal Bangalore, Jason Call, Stacey Clegg, Donald Cutlip, Nabil Dib, Paul Frey, Chao-Wei Hwang, Amanda Elliot, Peter V Johnston, Audrey Dudek, Steven Laster, John J Lopez, Carol Kartje, Kevin P Marzo, Ramesh B Daggubati, Mark Menegus, Dhananjai J Menzies, Mamoo Nakamura, Michael Ragosta, Ryan Reeves, Thomas Stuckey, Catalin Toma, Sean R Wilson, Shamir R Mehta, David A Wood, Robert F Storey, Roxana Mehran, Kevin R Bainey, Helen Nguyen, Brandi Meeks, Giuseppe Di Pasquale, Jose López-Sendón, David P Faxon, Laura Mauri, Sunil V Rao, Laurent Feldman, P Gabriel Steg, Álvaro Avezum, Tej Sheth, Natalia Pinilla-Echeverri, Raul Moreno, Gianluca Campo, Benjamin Wrigley, Sasko Kedev, Andrew Sutton, Richard Oliver, Josep Rodés-Cabau, Goran Stanković, Robert Welsh, Shahar Lavi, Warren J Cantor, Jia Wang, Juliet Nakamya, Shrikant I Bangdiwala, John A Cairns, COMPLETE Trial Steering Committee and Investigators, John Amerena, Chin Hiew, Stephen Duffy, Dion Stub, Ahmad Farshid, Melanie Freeman, Chris Zeitz, Irene M Lang, Lorenz Koller, Antoine Guedes, Suzanne Pourbaix, Paulo Caramori, Jose de Ribamar Costa Jr, José Francisco Kerr Saraiva, Adrian Kormann, Frederico Ultramari, J Antonio Marin-Neto, André A Schmidt, José C Nicolau, Remo H M Furtado, Márcio Santos, Michael B Tsang, Nicholas Valettas, James L Velianou, Chris Beck, Sadia Nauman, David A Wood, Warren J Cantor, Kim Robbins, Vladimír Džavík, Shahar Lavi, Robert C Welsh, Warren Ball, Kapil Bhagirath, Robert Boone, Asim N Cheema, Khrystyna Kushniriuk, Eric A Cohen, Payam Dehghani, Anthony Della Siega, Kushal Dighe, John Ducas, Saleem A Kassam, Hahn-Hoe Kim, André Kokis, S Najaf Nadeem, Michel Nguyen, Jean-Philippe Pelletier, Josep Rodés-Cabou, Erick Schampaert, Philippe Genereux, Bruce Sussex, Robert Teskey, Mouhieddin Traboulsi, Tycho Vuurmans, Brian Wong, Yuan Wu, Xiao-Shu Cheng, Qiang Fu, Wang Qingsheng, Jia Shaobin, Wei Wu, Ma Yitong, Yin Yuehui, Qun Zheng, Boris Vesga, Ota Hlinomaz, Erkki Ilveskoski, Olli Kajander, Laurent Feldman, Philippe Gabriel Steg, Jean Guillaume Dillinger, Olivier Dubreuil, Emile Ferrari, Olivier Nallet, Olivier Varenne, Thomas Schmitz, Alexander Wolf, Georgios Hahalis, Vassilis Voudris, John Tsorlalis, Antonios Ziakas, Iván Horváth, Zsolt Kőszegi, Zsuzsa Tokár, Shmuel Fuchs, Michael Kapeliovich, Giuseppe Di Pasquale, Elisa Filippini, Gianluca Campo, Simone Biscaglia, Fabrizio D'Ascenzo, Claudio Moretti, Vincenzo Guiducci, Gianluca Pignatelli, Reggio Emilia, Ferdinando Varbella, Giorgio Quadri, Darar A Al Khdair, Khaled Almerri, Vytautas Abraitis, Taida Ivanauskiene, Sasko Kedev, Darko Kitanoski, Juan Carlos Perez Alva, Bogdan Januś, Artur Baszko, Hélder Pereira, Fausto J Pinto, Pedro Carrilho Ferreira, Maria Dorobantu, Lucian Calmac, Noor Alkamel, Hani Altaradi, Mohammed A Alshehri, Mohammed A Anwar, Goran Stanković, Zlatko Mehmedbegovic, Mpiko Ntsekhe, Shaheen Pandie, Pravin Manga, Raul Moreno, Guillermo Galeote, Pablo Avanzas, Cesar Moris, Francisco Fernández Aviles, Antonio Fernandez Ortiz, José Ramón González Juanatey, Jose Seijas Amigo, Andrés Iñiguez, Victor Jiménez, Iñigo Lozano, Josepa Mauri Ferré, Ignacio Sánchez Pérez, Giovanna Sarno, Robert Kastberg, Florim Cuculi, Habib Haouala, Dhaker Lahidheb, Robert F Storey, James D Richardson, Sami Firoozi, Pitt Lim, Konrad Grosser, Jonathan Hill, Neville Kukreja, Vijay Kunadian, Louise Quinn, Joseph Mills, David E Newby, Philip D Adamson, Richard M Oliver, Alisdair Ryding, Jaydeep Sarma, Michael D Seddon, Dan McKenzie, Joanne Shannon, Andrew Sutton, Robin van Lingen, Sue Webber, Benjamin Wrigley, Salman Arain, Richard Bach, Sripal Bangalore, Jason Call, Stacey Clegg, Donald Cutlip, Nabil Dib, Paul Frey, Chao-Wei Hwang, Amanda Elliot, Peter V Johnston, Audrey Dudek, Steven Laster, John J Lopez, Carol Kartje, Kevin P Marzo, Ramesh B Daggubati, Mark Menegus, Dhananjai J Menzies, Mamoo Nakamura, Michael Ragosta, Ryan Reeves, Thomas Stuckey, Catalin Toma, Sean R Wilson
Abstract
Background: In patients with ST-segment elevation myocardial infarction (STEMI), percutaneous coronary intervention (PCI) of the culprit lesion reduces the risk of cardiovascular death or myocardial infarction. Whether PCI of nonculprit lesions further reduces the risk of such events is unclear.
Methods: We 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 or no further revascularization. Randomization was stratified according to the intended timing of nonculprit-lesion PCI (either during or after the index hospitalization). The first coprimary outcome was the composite of cardiovascular death or myocardial infarction; the second coprimary outcome was the composite of cardiovascular death, myocardial infarction, or ischemia-driven revascularization.
Results: At a median follow-up of 3 years, the first coprimary outcome had occurred in 158 of the 2016 patients (7.8%) in the complete-revascularization group as compared with 213 of the 2025 patients (10.5%) in the culprit-lesion-only PCI group (hazard ratio, 0.74; 95% confidence interval [CI], 0.60 to 0.91; P = 0.004). The second coprimary outcome had occurred in 179 patients (8.9%) in the complete-revascularization group as compared with 339 patients (16.7%) in the culprit-lesion-only PCI group (hazard ratio, 0.51; 95% CI, 0.43 to 0.61; P<0.001). For both coprimary outcomes, the benefit of complete revascularization was consistently observed regardless of the intended timing of nonculprit-lesion PCI (P = 0.62 and P = 0.27 for interaction for the first and second coprimary outcomes, respectively).
Conclusions: Among patients with STEMI and multivessel coronary artery disease, complete revascularization was superior to culprit-lesion-only PCI in reducing the risk of cardiovascular death or myocardial infarction, as well as the risk of cardiovascular death, myocardial infarction, or ischemia-driven revascularization. (Funded by the Canadian Institutes of Health Research and others; COMPLETE ClinicalTrials.gov number, NCT01740479.).
Copyright © 2019 Massachusetts Medical Society.
Source: PubMed