Complete Revascularization Best for STEMI With Multivessel CAD

For patients with ST-segment elevation myocardial infarction (STEMI) and multivessel coronary artery disease, complete revascularization is superior to culprit lesion-only percutaneous coronary intervention (PCI), according to a study published online Sept. 1 in the New England Journal of Medicine.

Shamir R. Mehta, M.D., from McMaster University in Hamilton, Ontario, Canada, and colleagues randomly assigned patients with STEMI and multivessel coronary artery disease who had undergone successful culprit-lesion PCI to either a strategy of complete revascularization with PCI of angiographically significant nonculprit lesions or no further revascularization. Patients were followed for a median of three years.

The researchers found that the first coprimary outcome (composite of cardiovascular death or myocardial infarction) occurred in 7.8 and 10.5 percent of patients in the complete-revascularization and culprit lesion-only PCI groups, respectively (hazard ratio, 0.74). The second coprimary outcome (composite of cardiovascular death, myocardial infarction, or ischemia-driven revascularization) occurred in 8.9 and 16.7 percent of patients, respectively (hazard ratio, 0.51). Regardless of the intended timing of nonculprit-lesion PCI, the benefit of complete revascularization was seen consistently for both coprimary outcomes.

"In light of the results of the well-planned and well-executed trial by Mehta et al., the guidelines should recommend a strategy of full revascularization in patients with STEMI and multivessel disease, at least in those who have suitable nonculprit lesions," write the authors of an accompanying editorial.

The study was partially funded by AstraZeneca and Boston Scientific.

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