scholarly journals Complete Revascularization in Patients Undergoing a Pharmacoinvasive Strategy for ST-Segment–Elevation Myocardial Infarction: Insights From the COMPLETE Trial

2021 ◽  
Author(s):  
Payam Dehghani ◽  
Warren J. Cantor ◽  
Jia Wang ◽  
David A. Wood ◽  
Robert F. Storey ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Cardiovascular Death ◽  
Hazard Ratio ◽  
Complete Revascularization ◽  
Primary Pci ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
Major Cardiovascular Events ◽  
St Segment ◽  
Artery Disease

Background: The COMPLETE trial (Complete Versus Culprit-Only Revascularization to Treat Multi-Vessel Disease After Early PCI for STEMI) demonstrated that staged nonculprit lesion percutaneous coronary intervention (PCI) reduced major cardiovascular events in patients with ST-segment–elevation myocardial infarction and multivessel coronary artery disease. It is unclear whether consistent benefit is observed in patients undergoing a pharmacoinvasive strategy compared with primary PCI. Methods: Following culprit lesion PCI, 4041 patients with ST-segment–elevation myocardial infarction and multivessel coronary artery disease were randomized to either routine nonculprit lesion PCI or culprit lesion only PCI. In a prespecified analysis, we determined the treatment effect in 303 patients undergoing a pharmacoinvasive strategy versus 3738 patients undergoing primary PCI on the first coprimary outcome of cardiovascular death or new myocardial infarction and the second coprimary outcome of cardiovascular death, new myocardial infarction, or ischemia-driven revascularization. Results: The first coprimary was reduced with complete revascularization both in the patients undergoing a pharmacoinvasive strategy (2.1%/y versus 4.7%/y, hazard ratio, 0.45 [95% CI, 0.21–0.97]) and in patients undergoing primary PCI (2.7%/y versus 3.6%/y, hazard ratio, 0.77 [95% CI, 0.62–0.95]; interaction P =0.18). The second coprimary outcome was reduced with complete revascularization in patients undergoing a pharmacoinvasive strategy (2.3%/y versus 8.5%/y, hazard ratio, 0.28 [95% CI, 0.14–0.56]), and in patients undergoing primary PCI (3.2%/y versus 6.0%/y, hazard ratio, 0.53 [95% CI, 0.44–0.64], interaction P =0.07). Conclusions: Among patients with ST-segment–elevation myocardial infarction and multivessel disease, complete revascularization with multivessel PCI consistently reduces major cardiovascular events in patients undergoing an initial pharmacoinvasive strategy as well as in those undergoing primary PCI. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT01740479.

scholarly journals Complete revascularization reduces cardiovascular death in patients with ST-segment elevation myocardial infarction and multivessel disease: systematic review and meta-analysis of randomized clinical trials

2019 ◽  
Vol 41 (42) ◽  
pp. 4103-4110 ◽  
Author(s):  
Rita Pavasini ◽  
Simone Biscaglia ◽  
Emanuele Barbato ◽  
Matteo Tebaldi ◽  
Dariusz Dudek ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Clinical Trials ◽  
Randomized Clinical Trials ◽  
Meta Analysis ◽  
Cardiovascular Death ◽  
Multivessel Disease ◽  
Complete Revascularization ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment

Abstract Aims The aim of this work was to investigate the prognostic impact of revascularization of non-culprit lesions in patients with ST-segment elevation myocardial infarction (STEMI) and multivessel disease by performing a meta-analysis of available randomized clinical trials (RCTs). Methods and results Data from six RCTs comparing complete vs. culprit-only revascularization in STEMI patients with multivessel disease were analysed with random effect generic inverse variance method meta-analysis. The endpoints were expressed as hazard ratio (HR) with 95% confidence interval (CI). The primary outcome was cardiovascular death. Main secondary outcomes of interest were all-cause death, myocardial infarction (MI), and repeated coronary revascularization. Overall, 6528 patients were included (3139 complete group, 3389 culprit-only group). After a follow-up ranging between 1 and 3 years (median 2 years), cardiovascular death was significantly reduced in the group receiving complete revascularization (HR 0.62, 95% CI 0.39–0.97, I2 = 29%). The number needed to treat to prevent one cardiovascular death was 70 (95% CI 36–150). The secondary endpoints MI and revascularization were also significantly reduced (HR 0.68, 95% CI 0.55–0.84, I2 = 0% and HR 0.29, 95% CI 0.22–0.38, I2 = 36%, respectively). Needed to treats were 45 (95% CI 37–55) for MI and 8 (95% CI 5–13) for revascularization. All-cause death (HR 0.81, 95% CI 0.56–1.16, I2 = 27%) was not affected by the revascularization strategy. Conclusion In a selected study population of STEMI patients with multivessel disease, a complete revascularization strategy is associated with a reduction in cardiovascular death. This reduction is concomitant with that of MI and the need of repeated revascularization.

Complete revascularization for patients with multivessel coronary artery disease and ST-segment elevation myocardial infarction after the COMPLETE trial: a meta-analysis of randomized controlled trial

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
G Bajraktari ◽  
I Bytyci ◽  
M.Y Henein ◽  
F Alfonso ◽  
A Ahmed ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Meta Analysis ◽  
Total Mortality ◽  
Complete Revascularization ◽  
Multivessel Coronary Artery Disease ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
Randomized Controlled ◽  
St Segment ◽  
Artery Disease

Abstract Background The recently published COMPLETE trial has demonstrated that patients with ST-segment elevation myocardial infarction (STEMI) and multivessel coronary artery disease (MVD), who underwent successful percutaneous coronary intervention (PCI) of both culprit and non-culprit (vs. culprit-only) lesion had a reduced risk of major adverse cardiac events (MACE: cardiovascular mortality, myocardial infarction, or ischemia-driven revascularization), but not of cardiovascular or total mortality. Aim To assess the efficacy of complete revascularization for cardiovascular or total mortality reduction by meta-analysis of all available randomized controlled trials (RCTs) including the COMPLETE trial. Methods PubMed, MEDLINE, Embase, Scopus, Google Scholar, CENTRAL and ClinicalTrials.gov databases search identified 10 RCTs of 7033 patients with STEMI and MVD which compared complete (n=3420) vs. only culprit lesion (n=3613) PCI for a median 28.7 months follow-up. Random effect risk ratios were used for efficacy and safety outcomes. Results Complete revascularization reduced the risk of MACE (10.4% vs. 16.6%; RR=0.59, 95% CI: 0.47 to 0.74, p<0.0001), CV mortality (2.87% vs. 3.72%; RR=0.73, 95% CI: 0.56 to 0.95, p=0.02), reinfarction (5.1% vs. 7.1%; RR=0.67, 95% CI: 0.52 to 0.86, p=0.002), urgent revascularization (7.92% vs. 17.4%; RR=0.47, 95% CI: 0.30 to 0.73, p<0.001), and CV hospitalization (8.68% vs. 11.4%; RR=0.65, 95% CI: 0.44to 0.96, p=0.03) compared with culprit only revascularization. All-cause mortality, stroke, major bleeding events, or contrast induced nephropathy were not affected by the revascularization strategy. Conclusion The findings of this meta-analysis suggest that in patients with STEMI and MVD, complete revascularization is superior to culprit-only PCI in reducing the risk of MACE outcomes, including cardiovascular mortality, without increasing the risk of adverse safety outcomes. Funding Acknowledgement Type of funding source: None

Abstract 1517: Does Angiogram Make A Difference In The Outcome Of Acute Coronary Syndrome? A Study On Sex Difference In Outcomes In South America.

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Raffaele Bugiardini ◽  
Florencia Rolandi ◽  
Oscar Bazzino ◽  
Olivia Manfrini ◽  
Andres Pascua ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Coronary Syndrome ◽  
Significant Coronary Artery Disease ◽  
Cardiovascular Death ◽  
Hazard Ratio ◽  
Entire Cohort ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
St Segment ◽  
Artery Disease

HYPOTHESIS. Women presenting with acute coronary syndrome are less likely to have significant coronary artery disease (CAD) than men, which could narrow wide differences in sex outcomes when evaluating the study population as a whole. METHODS. The Prognosis in Acute Coronary Syndromes Registry enrolled 823 patients (591 men and 232 women) who had been hospitalized for an acute coronary syndrome without ST-segment elevation and had undergone cardiac catheterization. We explored sex-based differences in presentation and outcomes, sorted by angiographic groups: obstructive (≥50% stenosis, accordingly to quantitative computerized analysis) versus non-obstructive CAD. Patients were followed up for 6 months. RESULTS. In obstructive CAD, women were older than men (71.4 ± 9.7 versus 64.4 ± 11.1 years, p<0.001), and had significantly higher rates of hypertension (51.9% versus 39.7%, p<0.001). Women were less likely to have smoked (19.3% versus 29.8%, p<0.01). A smaller percentage of women than men had non-ST elevation myocardial infarction as an index event (7.7% versus 22.8%, p<0.001) and positive troponin value (51.3% versus 67.4%, p<0.01). At follow-up women showed no differences in myocardial infarction, rehospitalization for unstable angina or revascularization, but they did suffer an increased rate of cardiovascular death (8.4% versus 3.4%, p<0.01), with a hazard ratio 2.34 (95%CI: 1.13– 4.84, p=0.023). Relation between sex and death remained significant even after adjustment for any confounders (hazard ratio 2.48; 95%CI: 1.19–5.15, p=0.015). In non-obstructive CAD group, the clinical characteristics and prognostic end-points (death: 0% men versus 1% women) did not significantly differ between men and women. CONCLUSIONS. In conclusion, women with obstructive CAD suffer an increased rate of cardiovascular death after acute coronary syndrome. Inclusion of large numbers of women with non-obstructive coronary disease in calculations based on the entire cohort may mistakenly shift results toward apparent outcome similarity with men.

scholarly journals Optimal Revascularization Strategy for Patients With ST-segment Elevation Myocardial Infarction and Multivessel Disease: A Pairwise and Network Meta-Analysis

2022 ◽  
Vol 8 ◽  
Author(s):  
Kongyong Cui ◽  
Dong Yin ◽  
Chenggang Zhu ◽  
Sheng Yuan ◽  
Shaoyu Wu ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Meta Analysis ◽  
Cardiovascular Death ◽  
Multivessel Disease ◽  
Current Evidence ◽  
Cochrane Library ◽  
Complete Revascularization ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment

Background: The relative benefit of immediate complete revascularization, staged complete revascularization, and culprit-only percutaneous coronary intervention (PCI) remains unclear in hemodynamically stable patients with ST-segment elevation myocardial infarction (STEMI) and multivessel disease. The aim of this study was to compare the clinical outcomes of the 3 PCI strategies in this population.Methods: We followed a pre-specified protocol (PROSPERO number: CRD42020183801). A comprehensive search of the electronic databases including PubMed, EMBASE and Cochrane Library from inception through February 21, 2020 was conducted. Randomized trials evaluating the comparative efficacy and safety of at least 2 of the 3 PCI strategies were identified. The primary endpoint was the composite of cardiovascular mortality or myocardial infarction (MI) during the longest follow-up. Pairwise and network meta-analyses were performed with random-effects model.Results: Eleven trials including 6,942 patients were analyzed. Pairwise meta-analysis noted that immediate complete revascularization and staged complete revascularization were respectively associated with a 52 and 27% reduction in the risk of cardiovascular death or MI (relative risk [RR] 0.48, 95% confidence interval [CI] 0.32–0.73, I2 = 0%; and RR 0.73, 95% CI 0.61–0.88, I2 = 0%, respectively), compared with culprit-only PCI. The risk of cardiovascular death or MI was not statistically different in staged and immediate complete revascularization groups (RR 0.88, 95% CI 0.45–1.72, I2 = 0%). Network meta-analysis obtained almost similar results compared with pairwise meta-analysis, and immediate complete revascularization had a 77% probability of being the best strategy for reducing cardiovascular death or MI among the 3 PCI strategies.Conclusion: The current evidence suggests that both immediate and staged complete revascularization were associated with a reduction of cardiovascular death or MI compared with culprit-only PCI. Further trials are warranted to directly compare immediate vs. staged complete revascularization in this population.Systematic Review Registration:https://www.crd.york.ac.uk/prospero/, PROSPERO [CRD42020183801].

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