Probabilities of treatment effects in complete or culprit-only revascularization for NSTEMI: A Bayesian re-analysis...

The completeness of revascularization in patients presenting with non-ST-elevation myocardial infarction (NSTEMI) and multivessel disease (MVD) remains understudied. The SLIM trial previously demonstrated a significant reduction in a composite endpoint of all-cause death, nonfatal myocardial infarction (MI), repeat revascularization, and stroke with complete revascularization under a frequentist framework. This post hoc Bayesian re-analysis offers a probabilistic interpretation beyond conventional significance testing.

The primary composite endpoint was analyzed as in the original trial, while secondary endpoints of the composite were evaluated individually. Analyses under multiple priors assessed robustness. The minimal clinically important difference (MCID) was defined as 5% absolute risk difference (ARD) for the composite endpoint and 1% for individual endpoints. The primary model used a weakly informative prior on the log relative risk (RR) scale within a normal-normal Bayesian framework.

Total 478 patients were randomized (complete: n = 240; culprit-only: n = 238). The posterior median RR for the composite endpoint was 0.41 (95% credible interval [CrI] 0.22-0.76), corresponding to an ARD of -7.9% (95% CrI -10.4% to -3.2%). The probability of any benefit was 99.8%, and the probability of meeting the MCID was 91.2%. For repeat revascularization, the ARD was -8.3% (95% CrI -10.0% to -4.5%), with a > 99.9% probability of clinically relevant benefit. For nonfatal MI, the ARD was -2.8% (95% CrI -4.2% to 0.9%), with a 94.8% probability of benefit. Results were consistent across all priors.

Complete revascularization provides a high probability of clinically meaningful benefit in NSTEMI patients with MVD, primarily through reductions in nonfatal MI and repeat revascularization.