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Multivessel PCI for Acute Myocardial Infarction: Where Do We Stand After The COMPLETE Trial?

Islam Y Elgendy1, Dhruv Mahtta2, David Paniagua3

  • 1Division of Cardiology, Weill Cornell Medicine-Qatar, Doha, Qatar. iyelgendy@gmail.com.

Current Cardiology Reports
|July 26, 2020
PubMed

Insights

Complete revascularization in ST-elevation myocardial infarction (STEMI) patients without cardiogenic shock reduces major adverse cardiac events, primarily myocardial infarction. This strategy, performed during hospitalization or after discharge, improves outcomes.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Clinical Trials

Background:

  • Multivessel coronary artery disease is common in patients undergoing primary percutaneous coronary intervention (PCI).
  • Previous trials suggested complete revascularization benefits STEMI patients without cardiogenic shock, mainly by reducing revascularization needs.

Purpose of the Study:

  • To evaluate the impact of complete revascularization on outcomes in STEMI patients without cardiogenic shock.
  • To determine if complete revascularization reduces cardiac mortality or myocardial infarction (MI) compared to culprit-only revascularization.

Main Methods:

  • The study analyzed data from the COMPLETE trial.
  • It compared complete revascularization (addressing all non-culprit stenoses) versus culprit-only revascularization in STEMI patients without cardiogenic shock.
  • Revascularization was performed during index hospitalization or after discharge.

Main Results:

  • Complete revascularization significantly reduced the risk of cardiac mortality or MI at a median of 3 years.
  • The benefit was driven by a reduction in MI risk.
  • No significant difference in cardiac mortality was observed.

Conclusions:

  • Complete revascularization of non-culprit lesions in STEMI patients without cardiogenic shock improves outcomes.
  • This strategy should be considered the default approach when feasible.
  • It reduces the risk of future myocardial infarction.
Abstract

Keywords:
Major adverse cardiac eventsMortalityMyocardial infarctionRevascularization

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