Virtual physiological analysis of non-culprit disease in patients with STEMI and multivessel disease: a substudy of the COMPLETE trial

Abstract

Aims

In the complete revascularization with multivessel PCI for myocardial infarction (COMPLETE) trial, staged complete revascularization in patients with ST-segment-elevation myocardial infarction (MI) reduced major adverse cardiovascular events compared with culprit-only revascularization. Inclusion was based on angiographic criteria.

Objectives

We modelled non-culprit virtual fractional flow reserve (vFFR) and investigated interactions between physiological lesion severity and the benefits of complete revascularization in COMPLETE.

Methods and results

All suitable angiograms from COMPLETE underwent software-based 3-dimensional (3D) arterial reconstruction and analysis of 3D-quantitative coronary angiography (QCA) and vFFR using computational fluid dynamics software. Physiological lesion significance was defined as vFFR ≤0.80 and was compared with operators’ visual angiographic analysis, 2D-QCA and 3D-QCA. vFFR was computed in 635 patients (710 lesions). 302 patients (48%) had ≥1 physiologically significant lesion and 333 (52%) had none. 321 (45%) lesions were physiologically significant and 389 (55%) were not. There was no statistically significant interaction between physiological lesion significance and any of the trial co-primary or key secondary clinical outcomes, or an exploratory outcome of ischaemia-driven revascularization without preceding MI (all interaction P > 0.30). 3D-QCA predicted vFFR significance more accurately than visual and 2D-QCA (concordance 73% vs. 49% vs. 59%, respectively).

Conclusion

In this virtual physiological substudy of the COMPLETE trial, 52% of patients lacked any physiologically significant lesions and the benefits of complete revascularization appeared to be independent of physiological lesion significance. 3D-QCA was a better predictor of physiological significance than either 2D-QCA or operator visual analysis. Further research is warranted to compare angiography-guided and physiology-guided complete revascularization strategies.

Metadata

Item Type:	Article
Authors/Creators:	Williams, G.J. Taylor, D.J. https://orcid.org/0000-0002-3270-6708 Al Baraikan, A. Haley, H. Ghobrial, M. https://orcid.org/0000-0002-3174-653X Knight, M. Anigboro, K. Rammohan, V. Gosling, R. https://orcid.org/0000-0001-7465-3563 Newman, T. Mills, M. Hose, R. Wood, D.A. Cairns, J.A. Ramasundarahettige, C. Khatun, R. Nguyen, H. Mehta, S.R. Storey, R.F. https://orcid.org/0000-0002-6677-6229 Gunn, J.P. Morris, P.D. https://orcid.org/0000-0002-3965-121X
Editors:	De Rosa, S.
Copyright, Publisher and Additional Information:	© The Author(s) 2025. Published by Oxford University Press on behalf of the European Society of Cardiology. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
Keywords:	virtual FFR; FFR; CFD; Myocardial infarction; Percutaneous coronary intervention; Coronary angiography
Dates:	Accepted: 15 May 2025 Published (online): 11 June 2025 Published: 11 June 2025
Institution:	The University of Sheffield
Academic Units:	The University of Sheffield > Faculty of Medicine, Dentistry and Health (Sheffield) > School of Medicine and Population Health
Funding Information:	Funder Grant number WELLCOME TRUST (THE) 214567/Z/18/Z National Institute for Health and Care Research II-LB-0216-20006 National Institute for Health and Care Research NIHR203321
Depositing User:	Symplectic Sheffield
Date Deposited:	16 Jun 2025 14:57
Last Modified:	16 Jun 2025 14:57
Status:	Published
Publisher:	Oxford University Press (OUP)
Refereed:	Yes
Identification Number:	10.1093/ehjopen/oeaf057
Open Archives Initiative ID (OAI ID):	oai:eprints.whiterose.ac.uk:227886

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Virtual physiological analysis of non-culprit disease in patients with STEMI and multivessel disease: a substudy of the COMPLETE trial

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