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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Complete revascularization with multivessel PCI for myocardial infarction
New England Journal of Medicine, Volume 381, No. 15, Year 2019
Notification
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Description
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. Copyright © 2019 Massachusetts Medical Society.
Authors & Co-Authors
Mehta, Shamir R.
Canada, Hamilton
Population Health Research Institute, Ontario
Wood, David A.
Canada, Vancouver
The University of British Columbia
Storey, Robert F.
United Kingdom, Sheffield
The University of Sheffield
Mehran, Roxana
United States, New York
Icahn School of Medicine at Mount Sinai
Nguyen, Helen K.
Canada, Hamilton
Population Health Research Institute, Ontario
Meeks, Brandi
Canada, Hamilton
Population Health Research Institute, Ontario
López-Sendón, José Luís
Spain, Madrid
Hospital Universitario la Paz
Faxon, David P.
United States, Boston
Harvard Medical School
Mauri, L.
United States, Boston
Harvard Medical School
Rao, Sunil V.
United States, Durham
Duke University Medical Center
Feldman, Laurent J.
France, Paris
Hôpital Bichat-claude-bernard Ap-hp
Steg, Philippe Gabriel
France, Paris
Hôpital Bichat-claude-bernard Ap-hp
Avezum, Álvaro Jr
Brazil, Sao Paulo
Instituto Dante Pazzanese de Cardiologia
Sheth, Tej Narendra
Canada, Hamilton
Population Health Research Institute, Ontario
Moreno, Raúl
Spain, Madrid
Hospital Universitario la Paz
Campo, Gianluca Calogero
Italy, Cona
Azienda Ospedaliero-universitaria Di Ferrara
Wrigley, Benjamin J.
United Kingdom, Wolverhampton
The Royal Wolverhampton Nhs Trust
Kedev, Saško A.
North Macedonia, Skopje
Ss Cyril and Methodius University
Rodés-Cabau, Josep
Canada, Quebec
Institut Universitaire de Cardiologie et de Pneumologie de Québec - Université Laval
Stanković, Goran R.
Serbia, Belgrade
Klinicki Centar Srbije
Welsh, Robert C.
Canada, Edmonton
Mazankowski Alberta Heart Institute
Cantor, Warren J.
Canada, Newmarket
Southlake Regional Health Centre
Wang, Jia
Canada, Hamilton
Population Health Research Institute, Ontario
Nakamya, Juliet
Canada, Hamilton
Population Health Research Institute, Ontario
Bangdiwala, Shrikant I.
Canada, Hamilton
Population Health Research Institute, Ontario
Cairns, J. A.
Canada, Vancouver
The University of British Columbia
Statistics
Citations: 495
Authors: 26
Affiliations: 20
Identifiers
Doi:
10.1056/NEJMoa1907775
ISSN:
00284793
Research Areas
Environmental
Noncommunicable Diseases
Study Design
Randomised Control Trial
Cohort Study