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N Engl J Med. 2019 Oct 10;381(15):1411-1421. doi: 10.1056/NEJMoa1907775. Epub 2019 Sep 1.

Complete Revascularization with Multivessel PCI for Myocardial Infarction.

Collaborators (186)

Amerena J, Hiew C, Duffy S, Stub D, Farshid A, Freeman M, Zeitz C, Lang IM, Koller L, Guedes A, Pourbaix S, Caramori P, de Ribamar Costa J Jr, Francisco Kerr Saraiva J, Kormann A, Ultramari F, Marin-Neto JA, Schmidt AA, Nicolau JC, Furtado RHM, Santos M, Tsang MB, Valettas N, Velianou JL, Beck C, Nauman S, Wood DA, Cantor WJ, Robbins K, Džavík V, Lavi S, Welsh RC, Ball W, Bhagirath K, Boone R, Cheema AN, Kushniriuk K, Cohen EA, Dehghani P, Della Siega A, Dighe K, Ducas J, Kassam SA, Kim HH, Kokis A, Nadeem SN, Nguyen M, Pelletier JP, Rodés-Cabou J, Schampaert E, Genereux P, Sussex B, Teskey R, Traboulsi M, Vuurmans T, Wong B, Wu Y, Cheng XS, Fu Q, Qingsheng W, Shaobin J, Wu W, Yitong M, Yuehui Y, Zheng Q, Vesga B, Hlinomaz O, Ilveskoski E, Kajander O, Feldman L, Steg PG, Dillinger JG, Dubreuil O, Ferrari E, Nallet O, Varenne O, Schmitz T, Wolf A, Hahalis G, Voudris V, Tsorlalis J, Ziakas A, Horváth I, Kőszegi Z, Tokár Z, Fuchs S, Kapeliovich M, Di Pasquale G, Filippini E, Campo G, Biscaglia S, D'Ascenzo F, Moretti C, Guiducci V, Pignatelli G, Emilia R, Varbella F, Quadri G, Al Khdair DA, Almerri K, Abraitis V, Ivanauskiene T, Kedev S, Kitanoski D, Perez Alva JC, Januś B, Baszko A, Pereira H, Pinto FJ, Carrilho Ferreira P, Dorobantu M, Calmac L, Alkamel N, Altaradi H, Alshehri MA, Anwar MA, Stanković G, Mehmedbegovic Z, Ntsekhe M, Pandie S, Manga P, Moreno R, Galeote G, Avanzas P, Moris C, Fernández Aviles F, Fernandez Ortiz A, González Juanatey JR, Seijas Amigo J, Iñiguez A, Jiménez V, Lozano I, Mauri Ferré J, Sánchez Pérez I, Sarno G, Kastberg R, Cuculi F, Haouala H, Lahidheb D, Storey RF, Richardson JD, Firoozi S, Lim P, Grosser K, Hill J, Kukreja N, Kunadian V, Quinn L, Mills J, Newby DE, Adamson PD, Oliver RM, Ryding A, Sarma J, Seddon MD, McKenzie D, Shannon J, Sutton A, Lingen RV, Webber S, Wrigley B, Arain S, Bach R, Bangalore S, Call J, Clegg S, Cutlip D, Dib N, Frey P, Hwang CW, Elliot A, Johnston PV, Dudek A, Laster S, Lopez JJ, Kartje C, Marzo KP, Daggubati RB, Menegus M, Menzies DJ, Nakamura M, Ragosta M, Reeves R, Stuckey T, Toma C, Wilson SR.

Author information

1
From the Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON (S.R.M., H.N., B.M., T.S., N.P.-E., J.N., J.W., S.I.B.), the University of British Columbia, Vancouver (D.A.W., J.A.C.), the University of Alberta, Mazankowski Alberta Heart Institute, Edmonton (K.R.B., R.W.), Institut Universitaire de Cardiologie et de Pneumologie de Québec, Quebec City (J.R.-C.), the University of Western Ontario, London Health Sciences Centre, London (S.L.), and the University of Toronto, Toronto Southlake Regional Health Centre, Toronto (W.J.C.) - all in Canada; the Department of Infection, Immunity, and Cardiovascular Disease, University of Sheffield, Sheffield (R.F.S.), the Royal Wolverhampton Hospitals NHS Trust, Wolverhampton (B.W.), the University Clinic of Cardiology, South Tees Hospitals NHS Foundation Trust, Middlesbrough (A.S.), and Hull University Teaching Hospitals NHS Trust, Hull (R.O.) - all in the United Kingdom; the Zena A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York (R.M.); Ospedale Maggiore, Bologna (G.D.P.), the Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, Cona (G.C.), and Maria Cecilia Hospital, GVM Care and Research, Cotignola (G.C.) - all in Italy; University Hospital La Paz, Madrid (J.L.-S., R.M.); Brigham and Women's Hospital and Harvard Medical School, Boston (D.P.F., L.M.); Duke University Medical Center, Durham, NC (S.V.R.); Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris (L.F., P.G.S.); Hospital Alemão Oswaldo Cruz, Instituto Dante Pazzanese de Cardiologia, São Paulo (A.A.); the University Clinic of Cardiology, University St. Cyril and Methodius, Skopje, Macedonia (S.K.); and the Clinical Center of Serbia, Belgrade (G.S.).

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.).

PMID:
31475795
DOI:
10.1056/NEJMoa1907775
[Indexed for MEDLINE]

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