# Timing van non-culprit revascularisatie bij STEMI: COMPLETE-trial

*geplaatst 2019-12-03 · Algemeen · Journal of the American College of Cardiology · doi 10.1016/j.jacc.2019.09.051 · https://hartvaat.nl/2019/12/03/timing-van-non-culprit-revascularisatie-bij-stemi-complete-trial/*

COMPLETE subanalyse naar de optimale timing van non-culprit revascularisatie bij STEMI met multivatenlijden.

## English: Timing of Staged Nonculprit Artery Revascularization in Patients With ST-Segment Elevation Myocardial Infarction: COMPLETE Trial.

This COMPLETE subanalysis examined the optimal timing of staged nonculprit revascularization in STEMI, finding that both early (during index hospitalization) and later (within 45 days) timing provided similar clinical benefit.

## Abstract (original, from the publication)

BACKGROUND: The COMPLETE (Complete vs Culprit-only Revascularization to Treat Multi-vessel Disease After Early PCI for STEMI) trial demonstrated that staged nonculprit lesion percutaneous coronary intervention (PCI) reduced major cardiovascular (CV) events in patients with ST-segment elevation myocardial infarction (STEMI) and multivessel coronary artery disease (CAD). OBJECTIVES: The purpose of this study was to determine the effect of nonculprit-lesion PCI timing on major CV outcomes and also the time course of the benefit of complete revascularization. METHODS: Following culprit-lesion PCI, 4,041 patients with STEMI and multivessel CAD were randomized to staged nonculprit-lesion PCI or culprit-lesion only PCI. Randomization was stratified according to investigator-planned timing of nonculprit-lesion PCI: during or after the index hospitalization. The first coprimary outcome was the composite of CV death or myocardial infarction (MI). In pre-specified analyses, hazard ratios (HRs) were calculated for each time stratum. Landmark analyses of the entire population were performed within 45 days and after 45 days. RESULTS: For nonculprit-lesion PCI planned during the index hospitalization (actual time: median 1 day), CV death or MI was reduced with complete revascularization compared with culprit-lesion only PCI (HR: 0.77; 95% confidence interval [CI]: 0.59 to 1.00). For nonculprit lesion PCI planned to occur after hospital discharge (actual time: median 23 days), CV death or MI was also reduced with complete revascularization (HR: 0.69; 95% CI: 0.49 to 0.97; interaction p = 0.62). Landmark analyses demonstrated an HR of 0.86 (95% CI: 0.59 to 1.24) during the first 45 days and 0.69 (95% CI: 0.54 to 0.89) from 45 days to the end of follow-up for intended nonculprit lesion PCI versus culprit lesion only PCI. CONCLUSIONS: Among STEMI patients with multivessel disease, the benefit of complete revascularization over culprit-lesion only PCI was consistent irrespective of the investigator-determined timing of nonculprit-lesion intervention. The benefit of complete revascularization on hard clinical outcomes emerged mainly over the long term.

Auteurs: David A Wood, John A Cairns, Jia Wang, Roxana Mehran, Robert F Storey, Helen Nguyen, Brandi Meeks, Vijay Kunadian, Jean-Francois Tanguay, Hahn-Ho Kim, Asim Cheema, Payam Dehghani, Madhu K Natarajan, Sanjit S Jolly, John Amerena, Matyas Keltai, Stefan James, Ota Hlinomaz, Kari Niemela, Khalid AlHabib, Basil S Lewis, Michel Nguyen, Jaydeep Sarma, Vladimir Dzavik, Anthony Della Siega, Shamir R Mehta

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Bron: Journal of the American College of Cardiology, https://doi.org/10.1016/j.jacc.2019.09.051. Bijgewerkt 2026-07-03T13:27:29Z. 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.