COMPLETE
Complete Revascularization with Multivessel PCI for Myocardial Infarction
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Overview
After culprit PCI for stable STEMI with multivessel CAD, staged complete revascularization reduced CV death or MI.
Clinical takeaway
COMPLETE is the major modern trial supporting planned complete revascularization in hemodynamically stable STEMI patients with multivessel disease after successful culprit-lesion PCI.
Key result
CV death or MI: 7.8% with complete revascularization vs 10.5% with culprit-only PCI; HR 0.74.
Practice impact
In stable STEMI with multivessel CAD, plan complete revascularization rather than leaving suitable nonculprit lesions untreated indefinitely.
Evidence
Study design
Randomized, open-label, multinational strategy trial.
Enrollment
4,041
Follow-up
Median 3 years.
Geography
Multinational
Clinical question
Does complete revascularization improve outcomes compared with culprit-lesion-only PCI after STEMI with multivessel disease?
Population
- Patients with STEMI and multivessel coronary artery disease after successful culprit-lesion PCI.
Intervention
Staged PCI of angiographically suitable nonculprit lesions during index hospitalization or after discharge.
Comparator
No routine nonculprit-lesion PCI after culprit-lesion PCI.
Primary outcome
Coprimary outcomes: cardiovascular death or MI; and cardiovascular death, MI, or ischemia-driven revascularization.
Complete revascularization reduced cardiovascular death or MI compared with culprit-lesion-only PCI.
Hazard ratio / 0.74 / CI 95% CI 0.60-0.91 / p=0.004
Key results
- CV death or MI: 7.8% with complete revascularization vs 10.5% with culprit-only PCI; HR 0.74; 95% CI 0.60-0.91; p=0.004.
- CV death, MI, or ischemia-driven revascularization: 8.9% vs 16.7%; HR 0.51; 95% CI 0.43-0.61; p<0.001.
- Benefit was consistent whether nonculprit PCI was intended during hospitalization or after discharge.
Harms
- Staged nonculprit PCI adds procedural exposure (contrast, radiation, access-site and periprocedural MI risk).
- Major bleeding, stroke, and contrast-associated acute kidney injury did not differ significantly between strategies.
Clinical Use
When to cite
- When planning staged nonculprit PCI after STEMI in stable patients.
Practice impact
- Supports planned nonculprit-lesion PCI in stable STEMI patients with suitable multivessel disease.
Applicability
- Most applicable after successful culprit-lesion PCI in hemodynamically stable STEMI patients.
Limitations
- Does not apply to cardiogenic shock physiology.
- Nonculprit lesions had to be suitable for PCI.
- Optimal timing of staged PCI remains individualized.
Common misinterpretations
- Do not use COMPLETE to support immediate multivessel PCI in unstable cardiogenic shock patients.
Related evidence
Citation
Mehta SR, Wood DA, Storey RF, et al. Complete Revascularization with Multivessel PCI for Myocardial Infarction. N Engl J Med. 2019;381(15):1411-1421. doi:10.1056/NEJMoa1907775
Complete revascularization was superior to culprit-lesion-only PCI.
- PMID
- 31475795