Mehta, S.R., Wood, D.A., Storey, R.F. orcid.org/0000-0002-6677-6229 et al. (29 more authors) (2019) Complete revascularization with multivessel PCI for myocardial infarction. New England Journal of Medicine, 381 (15). pp. 1411-1421. ISSN 0028-4793
Abstract
BACKGROUND
In patients with ST-segment elevation myocardial infarction (STEMI), percutaneous coronary intervention (PCI) of the culprit lesion reduces the risk of cardiovascular death or myocardial infarction. Whether PCI of nonculprit lesions further reduces the risk of such events is unclear.
METHODS
We randomly assigned patients with STEMI and multivessel coronary artery disease who had undergone successful culprit-lesion PCI to a strategy of either complete revascularization with PCI of angiographically significant nonculprit lesions or no further revascularization. Randomization was stratified according to the intended timing of nonculprit-lesion PCI (either during or after the index hospitalization). The first coprimary outcome was the composite of cardiovascular death or myocardial infarction; the second coprimary outcome was the composite of cardiovascular death, myocardial infarction, or ischemia-driven revascularization.
RESULTS
At a median follow-up of 3 years, the first coprimary outcome had occurred in 158 of the 2016 patients (7.8%) in the complete-revascularization group as compared with 213 of the 2025 patients (10.5%) in the culprit-lesion-only PCI group (hazard ratio, 0.74; 95% confidence interval [CI], 0.60 to 0.91; P=0.004). The second coprimary outcome had occurred in 179 patients (8.9%) in the complete-revascularization group as compared with 339 patients (16.7%) in the culprit-lesion-only PCI group (hazard ratio, 0.51; 95% CI, 0.43 to 0.61; P<0.001). For both coprimary outcomes, the benefit of complete revascularization was consistently observed regardless of the intended timing of nonculprit-lesion PCI (P=0.62 and P=0.27 for interaction for the first and second coprimary outcomes, respectively).
CONCLUSIONS
Among patients with STEMI and multivessel coronary artery disease, complete revascularization was superior to culprit-lesion-only PCI in reducing the risk of cardiovascular death or myocardial infarction, as well as the risk of cardiovascular death, myocardial infarction, or ischemia-driven revascularization. (Funded by the Canadian Institutes of Health Research and others; COMPLETE ClinicalTrials.gov number, NCT01740479. opens in new tab.)
Metadata
Item Type: | Article |
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Authors/Creators: |
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Copyright, Publisher and Additional Information: | © 2019 Massachusetts Medical Society. Reproduced in accordance with the publisher's self-archiving policy. |
Keywords: | Aged; Cardiovascular Diseases; Combined Modality Therapy; Coronary Artery Disease; Female; Follow-Up Studies; Humans; Kaplan-Meier Estimate; Male; Middle Aged; Myocardial Revascularization; Percutaneous Coronary Intervention; Purinergic P2Y Receptor Antagonists; Recurrence; ST Elevation Myocardial Infarction; Secondary Prevention; Stents |
Dates: |
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Institution: | The University of Sheffield |
Academic Units: | The University of Sheffield > Sheffield Teaching Hospitals |
Funding Information: | Funder Grant number SHEFFIELD TEACHING HOSPITALS NHS FOUNDATION TRUST STH18050 SHEFFIELD TEACHING HOSPITALS NHS FOUNDATION TRUST STH18050 |
Depositing User: | Symplectic Sheffield |
Date Deposited: | 05 Dec 2019 10:49 |
Last Modified: | 01 Mar 2020 01:38 |
Status: | Published |
Publisher: | Massachusetts Medical Society |
Refereed: | Yes |
Identification Number: | 10.1056/nejmoa1907775 |
Related URLs: | |
Open Archives Initiative ID (OAI ID): | oai:eprints.whiterose.ac.uk:154204 |