Complete multivessel PCI (R'SS=0) reduced CV death or new MI by 39% vs culprit-only PCI (6.6% vs 10.7%, HR 0.61); no benefit if revascularization incomplete.
Does achieving complete revascularization improve cardiovascular outcomes compared to culprit-only PCI in patients with STEMI and multivessel disease?
The reduction in major cardiovascular events with multivessel PCI in STEMI patients is dependent on actually achieving complete angiographic revascularization.
Absolute Event Rate: 0% vs 0%
Abstract Background In the COMPLETE trial (Complete versus Culprit-Only Revascularization Strategies to Treat Multivessel Disease after Early Percutaneous Coronary Intervention for ST-Segment Elevation Myocardial Infarction), a multivessel percutaneous coronary intervention (PCI) strategy was superior to culprit-only PCI in reducing ischemic events in patients with ST-elevation myocardial infarction (STEMI) and multivessel disease (MVD). Purpose To evaluate whether the completeness of revascularisation influences the effect of multivessel PCI versus culprit-lesion only revascularization among patients with STEMI and MVD based on a modified residual SYNTAX score (R’SS). Methods The COMPLETE trial randomized 4,041 patients with STEMI and MVD to either angiography-guided, staged multivessel PCI of all non-culprit lesions (NCLs) 70% stenosis or a culprit lesion-only strategy. An angiographic core lab evaluated all baseline and follow-up coronary angiograms for completeness of revascularization as assessed by the R’SS after NCL-PCI in the multivessel PCI group. A R’SS=0 indicated complete revascularization of all NCL’s with≥70% stenosis and a R’SS0 indicated incomplete revascularization with≥1 eligible NCLs not revascularized. The first coprimary outcome was cardiovascular death (CV-death) or new myocardial infarction (MI) and the second coprimary outcome was CV-death, new MI, or ischemia-driven revascularization. Results In the multivessel PCI group, 90% achieved complete revascularization (R'SS=0), while 10% did not (R'SS0). There were no major differences in baseline characteristics between the culprit lesion-only group, the multivessel PCI R’SS=0 and R’SS0 groups. Among patients in the multivessel PCI group achieving a R’SS=0, the first coprimary outcome occurred less frequently compared with those who underwent culprit lesion-only PCI (6.6% vs. 10.7%, HR 0.61 0.48-0.77). By contrast, among those with a R’SS0, there was no difference in the first coprimary outcome compared with the culprit lesion-only PCI group (10.7% vs. 10.7%, HR 0.98 0.61-1.57, interaction P0.001). Similarly, the second coprimary outcome was less common in the R’SS=0 group compared with the culprit lesion-only PCI group (7.4% vs. 17.1%, HR 0.41 0.33-0.51, whereas no difference was observed in patients with a R’SS0 and the culprit-only PCI group (HR 0.67 0.43-1.04, interaction P0.001), (Figure 1&2). Conclusions Among patients with STEMI and MVD randomized to a multivessel PCI strategy, those achieving complete revascularization as assessed in an angiographic core lab, experienced a significant reduction in major cardiovascular events compared with a culprit lesion-only strategy. By contrast, in patients randomized to a multivessel PCI strategy where complete revascularization was not achieved, no such benefit was observed. This finding implies that the benefit of multivessel PCI is dependent on actually achieving complete revascularization.Figure 1 Figure 2
Madanchi et al. (Sat,) reported a other. Complete multivessel PCI (R'SS=0) reduced CV death or new MI by 39% vs culprit-only PCI (6.6% vs 10.7%, HR 0.61); no benefit if revascularization incomplete.