Complete revascularization after STEMI leads to fewer recurrent Mis

Reference

Mehta SR, Wood DA, Storey RF, et al, for the COMPLETE Trial Steering Committee and Investigators. Complete revascularization with multivessel PCI for myocardial infarction. N Engl J Med 2019;381(15):1411-1421.

Synopsis

This study enrolled patients presenting with STEMI who had successful culprit-lesion percutaneous coronary intervention (PCI) and at least one additional angiographically significant nonculprit lesion that was amenable to PCI. Using concealed allocation, the investigators randomized these patients to receive either complete revascularization of all suitable nonculprit lesions (n = 2016) or culprit-lesion PCI only (n = 2025). Complete revascularization could occur at the index hospitalization or within 45 days of randomization. Both study groups also received guideline-based medical therapy. Baseline characteristics were similar in the 2 groups. For the primary outcome of death from cardiovascular causes or new MI at a median follow-up of 3 years, the complete revascularization group fared better than the culprit-lesion only group (7.8% vs 10.5%; HR 0.74; 95% CI 0.60 - 0.91; P = .004). This was due to fewer MIs in the the complete revascularization group (5.4% vs 7.9%; HR 0.68; 0.53 - 0.86). The complete revascularization group also had a decreased rate of ischemia-driven revascularization (1.4% vs 7.9%; HR 0.18; 0.12 - 0.26) and unstable angina (1.2% vs. 2.2%; HR 0.53; 0.40 - 0.71). There were no significant differences in the 2 groups in the risks of major bleeding, stroke, or stent thrombosis