Complete Revascularization vs Culprit Lesion–Only Percutaneous Coronary Intervention for Angina-Related Quality of Life in Patients With ST-Segment Elevation Myocardial Infarction
Authors: Mehta Shamir R. , Wang Jia , Wood David A. , Spertus John A. , Cohen David J. , Mehran Roxana , Storey Robert F. , Steg Philippe Gabriel , Pinilla-Echeverri Natalia , Sheth Tej , Bainey Kevin R. , Bangalore Sripal , Cantor Warren J. , Faxon David P. , Feldman Laurent J. , Jolly Sanjit S. , Kunadian Vijay , Lavi Shahar , Lopez-Sendon Jose , Madan Mina , Moreno Raul , Rao Sunil V. , Rodés-Cabau Josep , Stanković Goran , Bangdiwala Shrikant I. , Cairns John A. ,   COMPLETE Trial Investigators, Amerena John , Farshid Ahmad , Zeitz Chris , Duffy Stephen , Stub Dion , Freeman Melanie , Lang Irene , Pourbaix Suzanne , Guedes Antoine , Kormann Adrian , Caramori Paulo , Nicolau José Carlos , Santos Márcio , Marin-Neto José Antonio , Kerr Saraiva José Francisco , Costa Jose de Ribamar , Welsh Robert , Bhagirath Kapil , Kassam Saleem  A. , Della Siega Anthony , Džavík Vladimír , Boone Robert , Cheema Asim , Traboulsi Mouhieddin , Teskey Robert , Vuurmans Tycho , Ducas John , Cohen Eric , Nguyen Michel , Généreux Philippe , Schampaert Erick , Kim Hahn Hoe , Nadeem Najaf , Kokis André , Ball Warren , Dehghani Payam , Wong Brian , Sussex Bruce , Mansour Samer , Dighe Kushal , Pelletier Jean-Philippe , Wu Yuan , Cheng Xiao-Shu , Wang Qingsheng , Shaobin Jia , Yitong Ma , Yuehui Yin , Wu Wei , Zheng Qun , Fu Qiang , Vesga Boris , Hlinomaz Ota , Niemelä Kari , Varenne Olivier , Feldman Laurent , Dubreuil Olivier , Dillinger Jean Guillaume , Ferrari Emile , Nallet Olivier , Bruder Oliver , Hahalis Georgios , Ziakas Antonios , Voudris Vassilis , Kőszegi Zsolt , Horvath Ivan , Fuchs Shmuel , Kapeliovich Michael , D’Ascenzo Fabrizio , Di Pasquale Giuseppe , Guiducci Vincenzo , Campo Gianluca , Varbella Ferdinando , Al khdair Darar , Abraitis Vytautas , Kedev Sasko , Perez Alva Juan Carlos , Janus Bogdan , Baszko Artur , Pereira Hélder , Pinto Fausto , Dorobantu Maria , Alhabib Khalid , Al Shehri Mohammad , Ntsekhe Mpiko , Manga Pravin , Juanatey José Ramón González , Avanzas Pablo , Fernández Aviles Francisco , Iñiguez Andrés , Fernandez Ortiz Antonio , Mauri Fina , Lozano Iñigo , Sánchez Pérez Ignacio , Sarno Giovanna , Kastberg Robert , Cuculi Florim , Haouala Habib , Oliver Richard , Ryding Alisdair , Sutton Andrew , Newby David , Wrigley Benjamin , Firoozi Sam , Shannon Joanne , Seddon Michael , Kukreja Neville , Grosser Konrad , Mills Joseph , Webb Ian , Wells Tim , van Lingen Robin , Ragosta Michael , Johnston Peter , Wilson Sean , Clegg Stacey , Bach Richard , Cutlip Donald , Call Jason , Lopez John , Toma Catalin , Marzo Kevin , Frey Paul , Menegus Mark , Dib Nabil , Hwang Chao-Wei , Laster Steven , Reeves Ryan , Nakamura Mamoo , Arain Salman , Stuckey Thomas , Menzies Dhananjai 
Published: September 2022

Importance

In patients with multivessel coronary artery disease (CAD) presenting with ST-segment elevation myocardial infarction (STEMI), complete revascularization reduces major cardiovascular events compared with culprit lesion–only percutaneous coronary intervention (PCI). Whether complete revascularization also improves angina-related health status is unknown.

Objective

To determine whether complete revascularization improves angina status in patients with STEMI and multivessel CAD.

Design, Setting, and Participants

This secondary analysis of a randomized, multinational, open label trial of patient-reported outcomes took place in 140 primary PCI centers in 31 countries. Patients presenting with STEMI and multivessel CAD were randomized between February 1, 2013, and March 6, 2017. Analysis took place between July 2021 and December 2021.

Interventions

Following PCI of the culprit lesion, patients with STEMI and multivessel CAD were randomized to receive either complete revascularization with additional PCI of angiographically significant nonculprit lesions or to no further revascularization.

Main Outcomes and Measures

Seattle Angina Questionnaire Angina Frequency (SAQ-AF) score (range, 0 [daily angina] to 100 [no angina]) and the proportion of angina-free individuals by study end.

Results

Of 4041 patients, 2016 were randomized to complete revascularization and 2025 to culprit lesion–only PCI. The mean (SD) age of patients was 62 (10.7) years, and 3225 (80%) were male. The mean (SD) SAQ-AF score increased from 87.1 (17.8) points at baseline to 97.1 (9.7) points at a median follow-up of 3 years in the complete revascularization group (score change, 9.9 [95% CI, 9.0-10.8]; P &amp;lt; .001) compared with an increase of 87.2 (18.4) to 96.3 (10.9) points (score change, 8.9 [95% CI, 8.0-9.8]; P &amp;lt; .001) in the culprit lesion–only group (between-group difference, 0.97 points [95% CI, 0.27-1.67]; P = .006). Overall, 1457 patients (87.5%) were free of angina (SAQ-AF score, 100) in the complete revascularization group compared with 1376 patients (84.3%) in the culprit lesion–only group (absolute difference, 3.2% [95% CI, 0.7%-5.7%]; P = .01). This benefit was observed mainly in patients with nonculprit lesion stenosis severity of 80% or more (absolute difference, 4.7%; interaction P = .02).

Conclusions and Relevance

In patients with STEMI and multivessel CAD, complete revascularization resulted in a slightly greater proportion of patients being angina-free compared with a culprit lesion–only strategy. This modest incremental improvement in health status is in addition to the established benefit of complete revascularization in reducing cardiovascular events.