Complete Revascularization with Multivessel PCI for Myocardial Infarction

Mehta, Shamir R.; Wood, David; Storey, Robert F.; Mehran, Roxana; Bainey, Kevin R.; Nguyen, Helen; Meeks, Brandi; Pasquale, Giuseppe Di; López‐Sendón, José; Faxon, David P.; Mauri, Laura; Rao, Sunil V.; Feldman, Laurent J.; Steg, Philippe Gabríel; Avezum, Álvaro; Sheth, Tej; Pinilla-Echeverri, Natalia; Moreno, Raúl; Campo, Gianluca; Wrigley, Benjamin; Kedev, Saško; Sutton, Andrew; Oliver, Richard; Rodés‐Cabau, Josep; Stanković, Goran; Welsh, Robert C.; Lavi, Shahar; Cantor, Warren J.; Wang, Jia; Nakamya, Juliet; Bangdiwala, Shrikant I.; Cairns, John A.

doi:10.1056/nejmoa1907775

Cited by 567 publications

(446 citation statements)

References 25 publications

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“…By landmark analysis, we showed that the lack of benefit of CR in those with reduced LVEF was consistent both within the initial 30 days after PCI, and from the 30 days to three years. A recent trial showed that CR was superior to culprit-only PCI in STEMI patients with LVEF <45% [22]. Although the results seem to be inconsistent with our analysis, a few points should be noted before comparison.…”

Section: Cr In Stemi Patients With Reduced Lvef (Moderate To Severe Lcontrasting

confidence: 93%

Complete Revascularization of Multivessel Coronary Artery Disease Does Not Improve Clinical Outcome in ST-Segment Elevation Myocardial Infarction Patients with Reduced Left Ventricular Ejection Fraction

Kang

Zheng

Park

et al. 2020

JCM

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The benefit of complete revascularization (CR) in ST-segment elevation myocardial infarction (STEMI) patients with left ventricular (LV) dysfunction is uncertain. A total of 1314 STEMI patients with multivessel coronary artery disease were analyzed. CR was defined angiographically and by a residual Synergy between PCI with Taxus and Cardiac Surgery trial (SYNTAX) score (SS) <8. Patients with a left ventricular ejection fraction (LVEF) <40% were classified as the reduced LVEF group. The major study endpoints were patient-oriented composite outcome (POCO) and cardiac death during three-year follow-up. Overall, patients that received angiographic CR (579 patients, 44.1%) had significantly lower three-year clinical events compared with incomplete revascularization (iCR). CR reduced three-year POCO and cardiac death rates in the preserved LVEF group (POCO: 13.2% vs. 21.9%, p < 0.001, cardiac death: 1.8% vs. 6.5%, p < 0.001, respectively) but not in the reduced LVEF group (POCO: 26.0% vs. 33.1%, p = 0.275, cardiac death: 15.1% vs. 19.0%, p = 0.498, respectively). Multivariate analysis showed that CR significantly reduced three-year POCO (hazard ration (HR) 0.59, 95% confidence interval (CI) 0.43–0.82) and cardiac death (HR 0.34, 95% CI 0.14–0.80), only in the preserved LVEF group. Additionally, the results were corroborated using the SS-based CR definition. In STEMI patients with multivessel disease, CR did not improve clinical outcomes in those with reduced LVEF.

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Section: Cr In Stemi Patients With Reduced Lvef (Moderate To Severe Lcontrasting

confidence: 93%

Complete Revascularization of Multivessel Coronary Artery Disease Does Not Improve Clinical Outcome in ST-Segment Elevation Myocardial Infarction Patients with Reduced Left Ventricular Ejection Fraction

Kang

Zheng

Park

et al. 2020

JCM

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“…The Society for Cardiovascular Angiography and Interventions strives for accuracy in information and interpretation of the data for physicians providing care for patients. Two contemporary randomized controlled trials demonstrate the benefit of PCI in reducing the future risk of spontaneous MI and anginal burden in patients presenting with a STEMI or with stable ischemic heart disease . These studies help interventional cardiologists provide more accurate information to patients and provide additional data for an optimally balanced approach in discussing the risks and benefits of PCI procedures.…”

mentioning

confidence: 92%

“…This past year, results of two highly anticipated studies assessing the value of percutaneous coronary intervention (PCI) in patients with ischemic heart disease were reported at the European Society of Cardiology (ESC) and the American Heart Association (AHA) annual scientific sessions. In patients presenting with acute ST‐elevation myocardial infarction (STEMI) and multivessel coronary artery disease, the Complete versus Culprit‐Only Revascularization Strategies to Treat Multivessel Disease after Early PCI for STEMI (COMPLETE) trial demonstrated reduction in the future risk of myocardial infarction (MI) and ischemia‐driven revascularization with PCI and complete revascularization . Additionally, the International Study of Comparative Health Effectiveness with Medical and Invasive Approaches (ISCHEMIA) trial demonstrated that patients undergoing PCI for stable ischemic heart disease and moderate to severe ischemic burden have an improved quality of life and lower risk of future spontaneous MI with revascularization (predominantly with PCI in the trial)…”

mentioning

confidence: 99%

“…The multicenter, international COMPLETE trial was presented at the ESC Annual Scientific Sessions in September 2019. In this study, 4,041 STEMI patients who had undergone culprit lesion PCI were randomized to a strategy of complete revascularization with PCI of angiographically significant nonculprit lesions (during the index hospitalization or within 45 days) or culprit‐only revascularization . There were no patients enrolled in the trial who presented in cardiogenic shock and randomization was performed after the culprit lesion PCI procedure had been completed.…”

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confidence: 99%

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The COMPLETE and ISCHEMIA trials: Two contemporary studies showing percutaneous coronary intervention reduces the risk of myocardial infarction

Mahmud

2020

Cathet Cardio Intervent

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This past year, results of two highly anticipated studies assessing the value of percutaneous coronary intervention (PCI) in patients with ischemic heart disease were reported at the European Society of Cardiology (ESC) and the American Heart Association (AHA) annual scientific sessions. In patients presenting with acute STelevation myocardial infarction (STEMI) and multivessel coronary artery disease, the Complete versus Culprit-Only Revascularization Strategies to Treat Multivessel Disease after Early PCI for STEMI (COMPLETE) trial demonstrated reduction in the future risk of myocardial infarction (MI) and ischemia-driven revascularization with PCI and complete revascularization. 1 Additionally, the International Study of Comparative Health Effectiveness with Medical and Invasive Approaches (ISCHEMIA) trial demonstrated that patients undergoing PCI for stable ischemic heart disease and moderate to severe ischemic burden have an improved quality of life and lower risk of future spontaneous MI with revascularization (predominantly with PCI in the trial). 2,3The multicenter, international COMPLETE trial was presented at the ESC Annual Scientific Sessions in September 2019. In this study, 4,041 STEMI patients who had undergone culprit lesion PCI were randomized to a strategy of complete revascularization with PCI of angiographically significant nonculprit lesions (during the index hospitalization or within 45 days) or culprit-only revascularization. 1 There were no patients enrolled in the trial who presented in cardiogenic shock and randomization was performed after the culprit lesion PCI procedure had been completed. At a median follow-up of 3 years, cardiovascular death or new MI (co-primary endpoint) was reduced by 26% (7.8 vs. 10.5%; hazard ratio 0.74;95% CI 0.60-0.91, p = .004) while cardiovascular death, new MI, or ischemia-driven revascularization (second co-primary endpoint) was reduced by 49% (8.9 vs. 16.7%; hazard ratio 0.51; 95% CI 0.43-0.61, p < .001) in the complete revascularization group. The benefit was observed regardless of the timing of the staged PCI and included both a reduction of 32% in the future risk for MI (5.4 vs. 7.9%; hazard ratio 0.68; 95% CI 0.53-0.86) and 82% for ischemia-driven revascularization (1.4 vs. 7.9%; hazard ratio 0.18; 95% CI 0.12-0.26) in the complete revascularization group.In November 2019 at the AHA 2019 Scientific Sessions, results from the multicenter, international ISCHEMIA trial were presented. 2 A total of 5,179 patients with stable coronary artery disease and moderate to severe ischemia were randomized to routine invasive therapy (revascularization with PCI or CABG in 80%) versus optimal medical therapy. Prior to randomization, 73% of the subjects underwent coronary tomographic (CT) angiography to exclude left main coronary artery disease. Subjects with an ejection fraction of <35%, class III/IV congestive heart failure or dialysis dependent renal failure were also excluded. No difference in the primary endpoint (cardiovascular death, MI, hospitalization for uns...

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“…Percutaneous coronary intervention (PCI) has become one of the main methods of treating coronary artery stenosis or occlusion because it is minimally invasive and promotes rapid revascularization 1,2. However, after PCI some patients will have complications such as in‐stent restenosis, stent displacement, and stent malapposition 3,4.…”

Section: Introductionmentioning

confidence: 99%

Noninvasive detection of coronary artery stents by transthoracic echocardiography postprocessing subtraction technique

Xiao-yong

Chen

2020

Echocardiography

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Aim:To explore the feasibility and value of transthoracic echocardiography (TTE) postprocessing subtraction technique in the detection of a stent in the coronary artery. Method:Transthoracic echocardiography was used to examine 46 coronary artery stents in 30 patients by two-dimensional ultrasound postprocessing subtraction technique. The shape of each stent and its flow patency were observed. The patency was assessed according to blood flow and mosaic flow in the stent. Then, the results were compared with those of percutaneous coronary intervention (PCI) records and coronary angiography (CAG).Results: Transthoracic echocardiography detected 36 stents among 46 stents (two in the LMCA, 23 in the LAD, seven in the RCA, and two in the LCX); the detection rate was 78.3%. The average length of the stents was 21.8 ± 4.1 mm, and the average diameter was 2.4 ± 0.5 mm; both are shorter than those from PCI records (P < .001). Of the 36 stents, blood flow could be observed in 27. Compared with the results of CAG, TTE had 75% feasibility and 92.6% accuracy in detecting flow patency in the stents. Conclusion:Transthoracic echocardiography postprocessing subtraction technique could be a noninvasive method for detecting a coronary artery stent and, although the measurements of stent length and diameter were shorter than those of PCI records, an accurate detection of flow patency in the stents was achieved. K E Y W O R D Scoronary artery, echocardiography, postprocessing subtraction technique, stent

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Complete Revascularization with Multivessel PCI for Myocardial Infarction

Abstract: This is a repository copy of Complete revascularization with multivessel PCI for myocardial infarction.

Cited by 567 publications

References 25 publications

Complete Revascularization of Multivessel Coronary Artery Disease Does Not Improve Clinical Outcome in ST-Segment Elevation Myocardial Infarction Patients with Reduced Left Ventricular Ejection Fraction

Complete Revascularization of Multivessel Coronary Artery Disease Does Not Improve Clinical Outcome in ST-Segment Elevation Myocardial Infarction Patients with Reduced Left Ventricular Ejection Fraction

The COMPLETE and ISCHEMIA trials: Two contemporary studies showing percutaneous coronary intervention reduces the risk of myocardial infarction

Noninvasive detection of coronary artery stents by transthoracic echocardiography postprocessing subtraction technique

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