Patients initially receiving pharmacoinvasive strategy for ST elevation myocardial infarction (STEMI) also presenting multivessel disease consistently benefit from complete revascularization. This benefit is similar to that of primary PCI.
The COMPLETE showed that staged non-culprit lesion percutaneous coronary intervention (PCI) reduced major cardiovascular events in STEMI patients with multivessel coronary artery disease. This benefit was not clear for patients initially receiving antithrombotic medication not being able to access PCI right away.
Following successful culprit lesion PCI, STEMI 4041 patients with multivessel disease were randomized to either routine non-culprit lesion PCI or culprit lesion only PCI.
In a COMPLETE prespecified analysis, effect in 303 patients undergoing a pharmacoinvasive strategy was determined against 3738 patients undergoing primary PCI. Two primary end points were defined: on the one hand, cardiovascular death or new myocardial infarction and on the other hand, cardiovascular death, new myocardial infarction, or ischemia-driven revascularization.
The first primary end point was reduced with complete revascularization both in the patients undergoing a pharmacoinvasive strategy (2.1% vs 4.7%, HR 0.45, 95% CI, 0.21–0.97) and in patients undergoing primary PCI (2.7% vs 3.6%, HR 0.77, 95% CI, 0.62–0.95; interaction P=0.18).
The second primary end point was also reduced significantly with complete revascularization in patients undergoing an initial pharmacoinvasive strategy and in patients undergoing primary PCI.
Conclusion
Patients with multivessel disease with STEMI benefit from complete revascularization after treating the culprit lesion both with primary PCI and initial pharmacoinvasive strategy.
Orignal Title: Complete Revascularization in Patients Undergoing a Pharmacoinvasive Strategy for ST-Segment–Elevation Myocardial Infarction: Insights From the COMPLETE Trial.
Reference: Payam Dehghani et al. Circ Cardiovasc Interv. 2021 Aug;14(8):e010458. doi: 10.1161/CIRCINTERVENTIONS.120.010458.
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