{"id":"285a79c3ebb8","type":"article","url":"https://hartvaat.nl/2020/09/15/non-culprit-laesie-ernst-en-uitkomsten-bij-stemi-met-multivatenlijden/","title":"Non-culprit laesie-ernst en uitkomsten bij STEMI met multivatenlijden","title_en":"Nonculprit Lesion Severity and Outcome of Revascularization in Patients With STEMI and Multivessel Coronary Disease.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2020.07.034","source_url":"https://doi.org/10.1016/j.jacc.2020.07.034","authors":["Tej Sheth","Natalia Pinilla-Echeverri","Raul Moreno","Jia Wang","David A Wood","Robert F Storey","Roxana Mehran","Kevin R Bainey","Matthias Bossard","Sripal Bangalore","Jon-David Schwalm","James L Velianou","Nicholas Valettas","Matthew Sibbald","Josep Rodés-Cabau","John Ducas","Eric A Cohen","Akshay Bagai","Stephane Rinfret","David E Newby","Laurent Feldman","Steven B Laster","Irene M Lang","Joseph D Mills","John A Cairns","Shamir R Mehta"],"significance":6,"published":"2020-09-15","source_date":"2020-09-15","image":"","kennis":[],"congress":"","summary_en":"This COMPLETE analysis showed that the severity of nonculprit lesions influences outcomes after revascularization in STEMI with multivessel disease, supporting complete treatment of hemodynamically significant nonculprit stenoses.","created":"2026-07-03T10:28:45Z","updated":"2026-07-03T13:27:55Z","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":"Analyse naar de ernst van non-culprit laesies en de uitkomsten van revascularisatie bij STEMI met multivatencoronairlijden.","abstract_original":"BACKGROUND: In the COMPLETE (Complete vs Culprit-only Revascularization to Treat Multi-vessel Disease After Early PCI for STEMI) trial, angiography-guided percutaneous coronary intervention (PCI) of nonculprit lesions with the aim of complete revascularization reduced major cardiovascular (CV) events in patients with ST-segment elevation myocardial infarction (MI) and multivessel coronary artery disease. OBJECTIVES: The purpose of this study was to determine the effect of nonculprit-lesion stenosis severity measured by quantitative coronary angiography (QCA) on the benefit of complete revascularization. METHODS: Among 4,041 patients randomized in the COMPLETE trial, nonculprit lesion stenosis severity was measured using QCA in the angiographic core laboratory in 3,851 patients with 5,355 nonculprit lesions. In pre-specified analyses, the treatment effect in patients with QCA stenosis ≥60% versus <60% on the first coprimary outcome of CV death or new MI and the second co-primary outcome of CV death, new MI, or ischemia-driven revascularization was determined. RESULTS: The first coprimary outcome was reduced with complete revascularization in the 2,479 patients with QCA stenosis ≥60% (2.5%/year vs. 4.2%/year; hazard ratio [HR]: 0.61; 95% confidence interval [CI]: 0.47 to 0.79), but not in the 1,372 patients with QCA stenosis <60% (3.0%/year vs. 2.9%/year; HR: 1.04; 95% CI: 0.72 to 1.50; interaction p = 0.02). The second coprimary outcome was reduced in patients with QCA stenosis ≥60% (2.9%/year vs. 6.9%/year; HR: 0.43; 95% CI: 0.34 to 0.54) to a greater extent than patients with QCA stenosis <60% (3.3%/year vs. 5.2%/year; HR: 0.65; 95% CI: 0.47 to 0.89; interaction p = 0.04). CONCLUSIONS: Among patients with ST-segment elevation MI and multivessel coronary artery disease, complete revascularization reduced major CV outcomes to a greater extent in patients with stenosis severity of ≥60% compared with <60%, as determined by quantitative coronary angiography."}