This large analysis found no benefit at a 1-year follow-up to angioplasty of non-culprit vessels in elderly patients admitted with ST-segment elevation myocardial infarction.
The COMPLETE study was presented at the European Society of Cardiology 2019 Congress (and simultaneously published in NEJM) with evidence that seemed to leave no doubt regarding this issue. However, new research and sub-studies from the COMPLETE study conducted in the last two years have dimmed such certainty.
This research analyzed all patients >65 years old with multivessel disease admitted with ST-segment elevation myocardial infarction between 2009 and 2017. All procedures performed on other vessels within 45 days of infarction were defined as “non-culprit vessel angioplasty.”
The primary endpoint was a composite of death, infarction, and revascularization conducted between 45 days and a year after infarction.
About 56,332 patients were admitted to 1102 institutions. Of all patients, 37.7% underwent angioplasty in other vessels within 4 days of the index angioplasty for the infarction.
In a first analysis of raw data, complete revascularization was superior, but this effect was diluted after adjusting for multiple confounding variables.
Ultimately, non-culprit vessel angioplasty did not show a significant difference compared with primary angioplasty alone (p = 0.46) in this population >65 years.
Despite the multiple statistical adjustments made by the authors, this analysis is not without weaknesses (complete revascularization was left to operator’s discretion, the 45-day cut-off is arbitrary, among others).
Conclusion
In this large analysis with over 50,000 patients, no benefit could be found in performing multivessel angioplasty in elderly patients admitted with ST-segment elevation myocardial infarction. The benefit observed in large randomized studies may not be transferable to older patients and more complex decisions.
Original Title: Comparative Outcomes of Percutaneous Coronary Intervention for ST-Segment-Elevation Myocardial Infarction Among Medicare Beneficiaries With Multivessel Coronary Artery Disease: An National Cardiovascular Data Registry Research to Practice Project.
Reference: Eric A Secemsky et al. Circ Cardiovasc Interv. 2021 Aug;14(8):e010323. doi: 10.1161/CIRCINTERVENTIONS.120.010323.
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