Author + information
- Tej Sheth, MDa,b,∗@PHRIresearch (, )
- Natalia Pinilla-Echeverri, MDa,b,
- Raul Moreno, MDc,
- Jia Wang, MSca,b,
- David A. Wood, MDd,
- Robert F. Storey, MDe,
- Roxana Mehran, MDf,
- Kevin R. Bainey, MDg,
- Matthias Bossard, MDh,
- Sripal Bangalore, MDi,
- Jon-David Schwalm, MDa,b,
- James L. Velianou, MDb,
- Nicholas Valettas, MDb,
- Matthew Sibbald, MDb,
- Josep Rodés-Cabau, MDj,
- John Ducas, MDk,
- Eric A. Cohen, MDl,
- Akshay Bagai, MDm,
- Stephane Rinfret, MDn,
- David E. Newby, MDo,
- Laurent Feldman, MDp,
- Steven B. Laster, MDq,
- Irene M. Lang, MDr,
- Joseph D. Mills, MDs,
- John A. Cairns, MDd and
- Shamir R. Mehta, MD, MSca,b,∗@PHRIresearch ()
- aPopulation Health Research Institute, Hamilton, Ontario, Canada
- bMcMaster University, Hamilton Health Sciences, Hamilton, Ontario, Canada
- cUniversity Hospital La Paz, Madrid, Spain
- dUniversity of British Columbia, Vancouver, British Columbia, Canada
- eDepartment of Infection, Immunity, and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
- fZena A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
- gUniversity of Alberta, Mazankowski Alberta Heart Institute, Edmonton, Alberta, Canada
- hCardiology Division, Heart Center, Luzerner Kantonsspital, Luzern, Switzerland
- iNew York University School of Medicine, New York, New York
- jQuebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
- kUniversity of Manitoba, Winnipeg, Manitoba, Canada
- lSunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
- mTerrence Donnelly Heart Centre, St. Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada
- nMcGill University Health Centre, Montreal, Quebec, Canada
- oUniversity of Edinburgh, Edinburgh, United Kingdom
- pHôpital Bichat, Assistance Publique–Hôpitaux de Paris, Paris, France
- qSt. Luke’s Mid-America Heart Institute, University of Missouri–Kansas City School of Medicine, Kansas City, Missouri
- rVienna General Hospital, Medical University of Vienna, Vienna, Austria
- sLiverpool Heart and Chest Hospital, Liverpool, United Kingdom
- ↵∗Address for correspondence:
Dr. Tej Sheth OR Dr. Shamir R. Mehta, Population Health Research Institute, Hamilton Health Sciences, General Division, 237 Barton Street East, Hamilton, Ontario L8L 2X2, Canada.
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.
- percutaneous coronary intervention
- quantitative coronary angiography
- ST-segment elevation myocardial infarction
The COMPLETE trial was funded by the Canadian Institutes of Health Research with additional support from AstraZeneca, Boston Scientific, and Population Health Research Institute. Dr. Pinilla-Echeverri has received research grant support from the Fundacion Alfonso Martin Escudero during the conduct of the study; and has received personal fees from Abbott and Conavi, outside of the submitted work. Dr. Moreno has received personal fees from Medtronic, Boston Scientific, Abbott Vascular, Biotronik, Biosensors, Daiichi-Sankyo, Edwards, Amgen, and Bayer, outside the submitted work. Dr. Wood has received grants and other support from Edwards Lifesciences; and has received grants from Abbott and Boston Scientific, outside of the submitted work. Dr. Storey has received personal fees from Bayer, Bristol-Myers Squibb/Pfizer, Haemonetics, Amgen, Portola, and Medscape; and has received grants and personal fees from AstraZeneca, Thromboserin, and Glycardial Diagnostics, outside of the submitted work. Dr. Mehran has received grants, personal fees, and other support from Abbott Laboratories; has received grants from AstraZeneca, Bayer, Beth Israel Deaconess, CSL Behring, DSI, Medtronic, Novartis Pharmaceuticals, and OrbusNeich; has received grants and other support from Bristol-Myers Squibb; has served as a consultant (paid to the institution) for Spectranetics, Philips, and Volcano Corp.; has served on the Data Safety Monitoring Board (paid to the institution) for Watermark Research Partners; has equity (<1%) in Claret Medical and Elixir Medical; has received personal fees from Boston Scientific, Janssen Scientific Affairs, Medscape/WebMD, Roivant Services, Sanofi, Medtelligence (Janssen Scientific Affairs), Siemens Medical Solutions, the American College of Cardiology, and the American Medical Association; has received nonfinancial and other support from Idorsia Pharmaceuticals Ltd. and Regeneron Pharmaceuticals, outside of the submitted work; and her spouse has served as a consultant for Abiomed and The Medicines Company. Dr. Bossard has received personal fees from AstraZeneca, Amgen, and Bayer; and has received travel grants from Abbott Vascular, outside of the submitted work. Dr. Newby has received grants and personal fees from AstraZeneca, outside of the submitted work. Dr. Lang has received grants from Actelion and AOPOrphan Pharma; has received personal fees from Medtronic and Ferrer; and has received nonfinancial support from SCiPharm, outside of the submitted work. Dr. Cairns has received grants from Boston Scientific and AstraZeneca during the conduct of the study; and has received personal fees from Bristol-Myers Squibb, Bayer, and Abbott, outside of the submitted work. Dr. Mehta has received grants and other support from AstraZeneca and grants from Boston Scientific during the conduct of the study; and has received grants from AstraZeneca, outside of the submitted work. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. P.K. Shah, MD, served as Guest Editor-in-Chief for this paper.
The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC author instructions page.
- Received July 1, 2020.
- Accepted July 10, 2020.
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