Complete revascularization with multivessel PCI for myocardial infarction

Shamir R. Mehta, David A. Wood, Robert F. Storey, Roxana Mehran, Kevin R. Bainey, Helen Nguyen, Brandi Meeks, Giuseppe Di Pasquale, Jose López‑Sendón, David P. Faxon, Laura Mauri, Sunil V. Rao, Laurent Feldman, P. Gabriel Steg, Álvaro Avezum, Tej Sheth, Natalia Pinilla‑Echeverri, Raul Moreno, Gianluca Campo, Benjamin WrigleySasko Kedev, Andrew Sutton, Richard Oliver, Josep Rodés‑Cabau, Goran Stanković, Robert Welsh, Shahar Lavi, Warren J. Cantor, Jia Wang, Juliet Nakamya, Shrikant I. Bangdiwala, John A. Cairns

Research output: Contribution to journalArticlepeer-review

534 Scopus citations

Abstract

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.

Original languageEnglish
Pages (from-to)1411-1421
Number of pages11
JournalNew England Journal of Medicine
Volume381
Issue number15
DOIs
StatePublished - 10 Oct 2019

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