Tej Sheth1, Natalia Pinilla-Echeverri2, Raul Moreno3, Jia Wang2, David A Wood4, Robert F Storey5, Roxana Mehran6, Kevin R Bainey7, Matthias Bossard8, Sripal Bangalore9, Jon-David Schwalm2, James L Velianou10, Nicholas Valettas10, Matthew Sibbald10, Josep Rodés-Cabau11, John Ducas12, Eric A Cohen13, Akshay Bagai14, Stephane Rinfret15, David E Newby16, Laurent Feldman17, Steven B Laster18, Irene M Lang19, Joseph D Mills20, John A Cairns4, Shamir R Mehta1. 1. Population Health Research Institute, Hamilton, Ontario, Canada; McMaster University, Hamilton Health Sciences, Hamilton, Ontario, Canada. Electronic address: https://twitter.com/PHRIresearch. 2. Population Health Research Institute, Hamilton, Ontario, Canada; McMaster University, Hamilton Health Sciences, Hamilton, Ontario, Canada. 3. University Hospital La Paz, Madrid, Spain. 4. University of British Columbia, Vancouver, British Columbia, Canada. 5. Department of Infection, Immunity, and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom. 6. Zena A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York. 7. University of Alberta, Mazankowski Alberta Heart Institute, Edmonton, Alberta, Canada. 8. Cardiology Division, Heart Center, Luzerner Kantonsspital, Luzern, Switzerland. 9. New York University School of Medicine, New York, New York. 10. McMaster University, Hamilton Health Sciences, Hamilton, Ontario, Canada. 11. Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada. 12. University of Manitoba, Winnipeg, Manitoba, Canada. 13. Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada. 14. Terrence Donnelly Heart Centre, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada. 15. McGill University Health Centre, Montreal, Quebec, Canada. 16. University of Edinburgh, Edinburgh, United Kingdom. 17. Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris, France. 18. St. Luke's Mid-America Heart Institute, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri. 19. Vienna General Hospital, Medical University of Vienna, Vienna, Austria. 20. Liverpool Heart and Chest Hospital, Liverpool, United Kingdom.
Abstract
BACKGROUND: In the COMPLETE (Complete vs Culprit-only Revascularization to Treat Multi-vessel Disease After Early PCI for STEMI) trial, angiography-guided percutaneous coronary intervention (PCI) of nonculprit lesions with the aim of complete revascularization reduced major cardiovascular (CV) events in patients with ST-segment elevation myocardial infarction (MI) and multivessel coronary artery disease. OBJECTIVES: The purpose of this study was to determine the effect of nonculprit-lesion stenosis severity measured by quantitative coronary angiography (QCA) on the benefit of complete revascularization. METHODS: Among 4,041 patients randomized in the COMPLETE trial, nonculprit lesion stenosis severity was measured using QCA in the angiographic core laboratory in 3,851 patients with 5,355 nonculprit lesions. In pre-specified analyses, the treatment effect in patients with QCA stenosis ≥60% versus <60% on the first coprimary outcome of CV death or new MI and the second co-primary outcome of CV death, new MI, or ischemia-driven revascularization was determined. RESULTS: The first coprimary outcome was reduced with complete revascularization in the 2,479 patients with QCA stenosis ≥60% (2.5%/year vs. 4.2%/year; hazard ratio [HR]: 0.61; 95% confidence interval [CI]: 0.47 to 0.79), but not in the 1,372 patients with QCA stenosis <60% (3.0%/year vs. 2.9%/year; HR: 1.04; 95% CI: 0.72 to 1.50; interaction p = 0.02). The second coprimary outcome was reduced in patients with QCA stenosis ≥60% (2.9%/year vs. 6.9%/year; HR: 0.43; 95% CI: 0.34 to 0.54) to a greater extent than patients with QCA stenosis <60% (3.3%/year vs. 5.2%/year; HR: 0.65; 95% CI: 0.47 to 0.89; interaction p = 0.04). CONCLUSIONS: Among patients with ST-segment elevation MI and multivessel coronary artery disease, complete revascularization reduced major CV outcomes to a greater extent in patients with stenosis severity of ≥60% compared with <60%, as determined by quantitative coronary angiography.
BACKGROUND: In the COMPLETE (Complete vs Culprit-only Revascularization to Treat Multi-vessel Disease After Early PCI for STEMI) trial, angiography-guided percutaneous coronary intervention (PCI) of nonculprit lesions with the aim of complete revascularization reduced major cardiovascular (CV) events in patients with ST-segment elevation myocardial infarction (MI) and multivessel coronary artery disease. OBJECTIVES: The purpose of this study was to determine the effect of nonculprit-lesion stenosis severity measured by quantitative coronary angiography (QCA) on the benefit of complete revascularization. METHODS: Among 4,041 patients randomized in the COMPLETE trial, nonculprit lesion stenosis severity was measured using QCA in the angiographic core laboratory in 3,851 patients with 5,355 nonculprit lesions. In pre-specified analyses, the treatment effect in patients with QCA stenosis ≥60% versus <60% on the first coprimary outcome of CV death or new MI and the second co-primary outcome of CV death, new MI, or ischemia-driven revascularization was determined. RESULTS: The first coprimary outcome was reduced with complete revascularization in the 2,479 patients with QCA stenosis ≥60% (2.5%/year vs. 4.2%/year; hazard ratio [HR]: 0.61; 95% confidence interval [CI]: 0.47 to 0.79), but not in the 1,372 patients with QCA stenosis <60% (3.0%/year vs. 2.9%/year; HR: 1.04; 95% CI: 0.72 to 1.50; interaction p = 0.02). The second coprimary outcome was reduced in patients with QCA stenosis ≥60% (2.9%/year vs. 6.9%/year; HR: 0.43; 95% CI: 0.34 to 0.54) to a greater extent than patients with QCA stenosis <60% (3.3%/year vs. 5.2%/year; HR: 0.65; 95% CI: 0.47 to 0.89; interaction p = 0.04). CONCLUSIONS: Among patients with ST-segment elevation MI and multivessel coronary artery disease, complete revascularization reduced major CV outcomes to a greater extent in patients with stenosis severity of ≥60% compared with <60%, as determined by quantitative coronary angiography.
Authors: Shamir R Mehta; Jia Wang; David A Wood; John A Spertus; David J Cohen; Roxana Mehran; Robert F Storey; Philippe Gabriel Steg; Natalia Pinilla-Echeverri; Tej Sheth; Kevin R Bainey; Sripal Bangalore; Warren J Cantor; David P Faxon; Laurent J Feldman; Sanjit S Jolly; Vijay Kunadian; Shahar Lavi; Jose Lopez-Sendon; Mina Madan; Raul Moreno; Sunil V Rao; Josep Rodés-Cabau; Goran Stankovic; Shrikant I Bangdiwala; John A Cairns Journal: JAMA Cardiol Date: 2022-09-21 Impact factor: 30.154
Authors: Andrew Lin; Márton Kolossváry; Sebastien Cadet; Priscilla McElhinney; Markus Goeller; Donghee Han; Jeremy Yuvaraj; Nitesh Nerlekar; Piotr J Slomka; Mohamed Marwan; Stephen J Nicholls; Stephan Achenbach; Pál Maurovich-Horvat; Dennis T L Wong; Damini Dey Journal: JACC Cardiovasc Imaging Date: 2022-01-12
Authors: Eric A Secemsky; Neel Butala; Aishwarya Raja; Rohan Khera; Yongfei Wang; Jeptha P Curtis; Thomas M Maddox; Salim S Virani; Ehrin J Armstrong; Kendrick A Shunk; Ralph G Brindis; Deepak Bhatt; Robert W Yeh Journal: Circ Cardiovasc Interv Date: 2021-08-10 Impact factor: 7.514