{"id":"e8b2067e1573","type":"article","url":"https://hartvaat.nl/2019/10/10/complete-revascularisatie-met-multivaten-pci-bij-mi-nejm-complete/","title":"Complete revascularisatie met multivaten-PCI bij MI: NEJM COMPLETE","title_en":"Complete Revascularization with Multivessel PCI for Myocardial Infarction.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa1907775","source_url":"https://doi.org/10.1056/NEJMoa1907775","authors":["Shamir R Mehta","David A Wood","Robert F Storey","Roxana Mehran","Kevin R Bainey","Helen Nguyen","Brandi Meeks","Giuseppe Di Pasquale","Jose López-Sendón","David P Faxon","Laura Mauri","Sunil V Rao","Laurent Feldman","P Gabriel Steg","Álvaro Avezum","Tej Sheth","Natalia Pinilla-Echeverri","Raul Moreno","Gianluca Campo","Benjamin Wrigley","Sasko Kedev","Andrew Sutton","Richard Oliver","Josep Rodés-Cabau","Goran Stanković","Robert Welsh","Shahar Lavi","Warren J Cantor","Jia Wang","Juliet Nakamya","Shrikant I Bangdiwala","John A Cairns"],"significance":10,"published":"2019-10-10","source_date":"2019-10-10","image":"","kennis":["https://hartvaat.nl/kennis/antistolling/dubbele-antistolling-indicaties/"],"congress":"","summary_en":"The COMPLETE trial showed that routine complete revascularization of nonculprit lesions during the index hospitalization or shortly thereafter reduced cardiovascular death and MI compared with culprit-only PCI in patients with STEMI and multivessel disease. This provided definitive evidence for a strategy of staged complete revascularization after primary PCI.","created":"2026-07-03T10:28:11Z","updated":"2026-07-03T13:27:23Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Landmark NEJM COMPLETE-trial die aantoonde dat complete revascularisatie (routine non-culprit PCI) superieur is aan culprit-only bij MI met multivatenlijden. Definitief bewijs voor volledige revascularisatie.","abstract_original":"BACKGROUND: In patients with ST-segment elevation myocardial infarction (STEMI), percutaneous coronary intervention (PCI) of the culprit lesion reduces the risk of cardiovascular death or myocardial infarction. Whether PCI of nonculprit lesions further reduces the risk of such events is unclear. METHODS: We randomly assigned patients with STEMI and multivessel coronary artery disease who had undergone successful culprit-lesion PCI to a strategy of either complete revascularization with PCI of angiographically significant nonculprit lesions or no further revascularization. Randomization was stratified according to the intended timing of nonculprit-lesion PCI (either during or after the index hospitalization). The first coprimary outcome was the composite of cardiovascular death or myocardial infarction; the second coprimary outcome was the composite of cardiovascular death, myocardial infarction, or ischemia-driven revascularization. RESULTS: At a median follow-up of 3 years, the first coprimary outcome had occurred in 158 of the 2016 patients (7.8%) in the complete-revascularization group as compared with 213 of the 2025 patients (10.5%) in the culprit-lesion-only PCI group (hazard ratio, 0.74; 95% confidence interval [CI], 0.60 to 0.91; P = 0.004). The second coprimary outcome had occurred in 179 patients (8.9%) in the complete-revascularization group as compared with 339 patients (16.7%) in the culprit-lesion-only PCI group (hazard ratio, 0.51; 95% CI, 0.43 to 0.61; P<0.001). For both coprimary outcomes, the benefit of complete revascularization was consistently observed regardless of the intended timing of nonculprit-lesion PCI (P = 0.62 and P = 0.27 for interaction for the first and second coprimary outcomes, respectively). CONCLUSIONS: Among patients with STEMI and multivessel coronary artery disease, complete revascularization was superior to culprit-lesion-only PCI in reducing the risk of cardiovascular death or myocardial infarction, as well as the risk of cardiovascular death, myocardial infarction, or ischemia-driven revascularization. (Funded by the Canadian Institutes of Health Research and others; COMPLETE ClinicalTrials.gov number, NCT01740479.)."}