Population Health Research Institute, Hamilton, Ontario, Canada; McMaster University, Hamilton Health Sciences, Hamilton, Ontario, Canada. Electronic address: https://twitter.com/PHRIresearch.
Population Health Research Institute, Hamilton, Ontario, Canada; McMaster University, Hamilton Health Sciences, Hamilton, Ontario, Canada.
J Am Coll Cardiol. 2020 Sep 15;76(11):1277-1286. doi: 10.1016/j.jacc.2020.07.034.
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.
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.
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.
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).
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.
在 COMPLETE（STEMI 早期 PCI 后罪犯病变与非罪犯病变血运重建的完全与部分血运重建对比）试验中，经造影指导的非罪犯病变经皮冠状动脉介入治疗（PCI）旨在实现完全血运重建，从而降低 ST 段抬高型心肌梗死（STEMI）合并多支血管病变患者的主要心血管（CV）事件。
本研究旨在确定定量冠状动脉造影（QCA）测量的非罪犯病变狭窄严重程度对完全血运重建获益的影响。
在 COMPLETE 试验中，4041 例患者随机分组，其中 3851 例患者（5355 处非罪犯病变）在造影核心实验室采用 QCA 测量非罪犯病变狭窄程度。在预先设定的分析中，确定 QCA 狭窄≥60%与<60%的患者首次主要复合终点（CV 死亡或新发心肌梗死）和次要主要复合终点（CV 死亡、新发心肌梗死或缺血驱动的血运重建）的治疗效果。
在 2479 例 QCA 狭窄≥60%的患者中，完全血运重建降低了首次主要复合终点的发生率（2.5%/年 vs. 4.2%/年；风险比[HR]：0.61；95%置信区间[CI]：0.47 至 0.79），但在 1372 例 QCA 狭窄<60%的患者中未见此获益（3.0%/年 vs. 2.9%/年；HR：1.04；95%CI：0.72 至 1.50；交互 p=0.02）。在 QCA 狭窄≥60%的患者中，次要主要复合终点的发生率降低（2.9%/年 vs. 6.9%/年；HR：0.43；95%CI：0.34 至 0.54）的程度大于 QCA 狭窄<60%的患者（3.3%/年 vs. 5.2%/年；HR：0.65；95%CI：0.47 至 0.89；交互 p=0.04）。
在 STEMI 合并多支血管病变患者中，与 QCA 狭窄<60%的患者相比，QCA 狭窄≥60%的患者完全血运重建可更大程度地降低主要 CV 结局，而 QCA 狭窄<60%的患者完全血运重建获益不明显。
