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

Centre for Cardiovascular Innovation St Paul's and Vancouver General Hospitals University of British Columbia Vancouver British Columbia Canada

Department of Cardiac Services King Fahad Cardiac Center Saudi Arabia

Department of Cardiac Services Victoria Heart Institute Foundation Victoria British Columbia Canada

Department of Infection Immunity and Cardiovascular Disease University of Sheffield Sheffield United Kingdom

Division of Cardiology Centre Hospitalier Universitaire de Sherbrooke Quebec Quebec Canada

Heart Centre Tampere University Hospital Tampere Finland

Hungarian Institute of Cardiology Budapest Hungary

Institute of Cellular Medicine Faculty of Medical Sciences Newcastle University and Cardiothoracic Centre Freeman Hospital Newcastle upon Tyne Hospitals NHS Foundation Trust Newcastle upon Tyne United Kingdom

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

Population Health Research Institute McMaster University and Hamilton Health Sciences Hamilton 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

J Am Coll Cardiol. 2019 Dec 3;74(22):2724-2727. doi: 10.1016/j.jacc.2019.10.022. PubMed

J Am Coll Cardiol. 2020 Apr 28;75(16):2092-2093. doi: 10.1016/j.jacc.2019.12.073. PubMed

J Am Coll Cardiol. 2020 Apr 28;75(16):2093. doi: 10.1016/j.jacc.2019.12.074. PubMed

J Am Coll Cardiol. 2020 Apr 28;75(16):2093-2094. doi: 10.1016/j.jacc.2020.02.049. PubMed

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