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Timing of Staged Nonculprit Artery Revascularization in Patients With ST-Segment Elevation Myocardial Infarction: COMPLETE Trial
DA. Wood, JA. Cairns, J. Wang, R. Mehran, RF. Storey, H. Nguyen, B. Meeks, V. Kunadian, JF. Tanguay, HH. Kim, A. Cheema, P. Dehghani, MK. Natarajan, SS. Jolly, J. Amerena, M. Keltai, S. James, O. Hlinomaz, K. Niemela, K. AlHabib, BS. Lewis, M....
Jazyk angličtina Země Spojené státy americké
Typ dokumentu časopisecké články, multicentrická studie, randomizované kontrolované studie, práce podpořená grantem
Grantová podpora
CS/15/7/31679
British Heart Foundation - United Kingdom
NLK
Free Medical Journals
od 1983 do Před 1 rokem
Open Access Digital Library
od 1998-01-01
- MeSH
- časové faktory MeSH
- elektrokardiografie MeSH
- infarkt myokardu s elevacemi ST úseků diagnóza chirurgie MeSH
- koronární angiografie MeSH
- koronární angioplastika metody MeSH
- koronární cévy diagnostické zobrazování chirurgie MeSH
- lidé středního věku MeSH
- lidé MeSH
- následné studie MeSH
- výsledek terapie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
- práce podpořená grantem MeSH
- randomizované kontrolované studie MeSH
BACKGROUND: The COMPLETE (Complete vs Culprit-only Revascularization to Treat Multi-vessel Disease After Early PCI for STEMI) trial demonstrated that staged nonculprit lesion percutaneous coronary intervention (PCI) reduced major cardiovascular (CV) events in patients with ST-segment elevation myocardial infarction (STEMI) and multivessel coronary artery disease (CAD). OBJECTIVES: The purpose of this study was to determine the effect of nonculprit-lesion PCI timing on major CV outcomes and also the time course of the benefit of complete revascularization. METHODS: Following culprit-lesion PCI, 4,041 patients with STEMI and multivessel CAD were randomized to staged nonculprit-lesion PCI or culprit-lesion only PCI. Randomization was stratified according to investigator-planned timing of nonculprit-lesion PCI: during or after the index hospitalization. The first coprimary outcome was the composite of CV death or myocardial infarction (MI). In pre-specified analyses, hazard ratios (HRs) were calculated for each time stratum. Landmark analyses of the entire population were performed within 45 days and after 45 days. RESULTS: For nonculprit-lesion PCI planned during the index hospitalization (actual time: median 1 day), CV death or MI was reduced with complete revascularization compared with culprit-lesion only PCI (HR: 0.77; 95% confidence interval [CI]: 0.59 to 1.00). For nonculprit lesion PCI planned to occur after hospital discharge (actual time: median 23 days), CV death or MI was also reduced with complete revascularization (HR: 0.69; 95% CI: 0.49 to 0.97; interaction p = 0.62). Landmark analyses demonstrated an HR of 0.86 (95% CI: 0.59 to 1.24) during the first 45 days and 0.69 (95% CI: 0.54 to 0.89) from 45 days to the end of follow-up for intended nonculprit lesion PCI versus culprit lesion only PCI. CONCLUSIONS: Among STEMI patients with multivessel disease, the benefit of complete revascularization over culprit-lesion only PCI was consistent irrespective of the investigator-determined timing of nonculprit-lesion intervention. The benefit of complete revascularization on hard clinical outcomes emerged mainly over the long term.
Cardiovascular Clinical Research Institute Lady Davis Carmel Medical Center Haifa Israel
Department of Cardiac Services King Fahad Cardiac Center Saudi Arabia
Department of Cardiac Services Victoria Heart Institute Foundation Victoria British Columbia Canada
Division of Cardiology Centre Hospitalier Universitaire de Sherbrooke Quebec Quebec Canada
Heart Centre Tampere University Hospital Tampere Finland
Hungarian Institute of Cardiology Budapest Hungary
Kardinia House Geelong Victoria Australia
Montreal Heart Institute and Universite de Montreal Montreal Quebec Canada
North West Heart Centre Wythenshawe Hospital Manchester United Kingdom
Peter Munk Cardiac Centre University Health Network Toronto Ontario Canada
Prairie Vascular Research Network University of Saskatchewan Regina Saskatchewan Canada
St Mary's General Hospital Kitchener Ontario Canada
St Michael's Hospital Toronto Ontario Canada
The Zena A Wiener Cardiovascular Institute Icahn School of Medicine at Mount Sinai New York New York
University Hospital St Anne Brno Czech Republic
Uppsala Clinical Research Centre and Department of Medical Sciences Uppsala Sweden
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