Complete Revascularization Reduces Both Event Risk and Angina Burden in STEMI

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Deepak Bhatt, MD, MPH, discusses the results of a prespecified analysis of the COMPLETE detailing a complete revascularization approach to PCI in STEMI resulted in less angina burden than a culprit-lesion-only approach at 3 years.

New research from the COMPLETE trial details the benefits of strategy using complete revascularization versus culprit-lesion-only strategy not only for reducing risk of major events, but also improving angina-related quality of life.

Presented at the American College of Cardiology’s 71st Annual Scientific Sessions, results of the analysis demonstrate a strategy with complete revascularization resulted in less residual angina and improved sub scale scores on the Seattle Angina Questionnaire (SAQ) compared to a culprit-lesion-only strategy.

Upon being published in the New England Journal of Medicine in October 2019, the COMPLETE trial provided investigators with an evidence-based approach to deciding between a culprit-lesion-only and complete revascularization approach to PCI in patients with ST-segment elevation myocardial infarction (STEMI). Results of the trial, which indicated complete revascularization was associated with a 26% reduction in relative risk of cardiovascular death or new myocardial infarction and a 49% reduction in relative risk of cardiovascular death, new myocardial infarction, or ischemic driven revascularization, led to a class 1 recommendation in the 2021 ACC/AHA/AATS/STS/SCAI guideline for coronary artery revascularization.

The prespecified analysis from ACC.22, which was presented by Shamir Mehta, MD, of McMaster University, contained 1666 who underwent complete revascularization and 1632 who underwent culprit-lesion-only revascularization with SAQ frequency scores at baseline, month 6, and end of the study. Results of the analysis suggested either strategy was associated with improved angina-related quality of life compared to baseline measurements.

Further analysis suggested a greater proportion of patients were free of angina in the complete revascularization group than in the culprit-lesion-only group the in the culprit-lesion-only group, with 84.3% of the culprit-lesion-only group angina free at 3 years compared to 87.5% of the complete revascularization group (ARD, 3.2% [95% CI, 0.7-5.7]; P=.013) , which investigators noted correlates to a NNT of 31 to prevent 1 patient from experiencing angina at a median follow-up of 3 years. Investigators noted the benefit of complete revascularization was most apparent in patients with NCL stenosis severity at or above 80%.

During an interview with Deepak Bhatt, MD, MPH, executive director of interventional cardiovascular programs at Brigham and Women’s Hospital, at ACC.22, Bhatt chose the COMPLETE analysis as a study of interest from this year’s meeting. For more insight in to clinical applicability of this data, that portion of the interview can be found below.

This study, “Effects Of Complete Revascularization On Angina-related Quality Of Life In Patients With St-segment Elevation Myocardial Infarction,” was presented at ACC.22.