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.

中文翻译：

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ST段抬高型心肌梗死患者分期非罪犯动脉血运重建的时机

背景 COMPLETE（完全与仅罪犯血运重建治疗 STEMI 早期 PCI 后多支血管疾病）试验表明，分期非罪犯病变经皮冠状动脉介入治疗 (PCI) 减少了 ST 段抬高型心肌梗死患者的主要心血管 (CV) 事件(STEMI) 和多支冠状动脉疾病 (CAD)。目的 本研究的目的是确定非罪犯病变 PCI 时间对主要心血管结局的影响，以及完全血运重建获益的时间过程。方法 在罪犯病变 PCI 后，4,041 名 STEMI 和多支血管 CAD 患者随机接受分期非罪犯病变 PCI 或仅罪犯病变 PCI。根据研究者计划的非罪犯病变 PCI 时间对随机化进行分层：在首次住院期间或之后。第一个共同主要结局是心血管死亡或心肌梗死 (MI) 的复合结局。在预先指定的分析中，计算了每个时间层的风险比 (HR)。在 45 天内和 45 天后对整个群体进行了标志性分析。结果 对于首次住院期间计划的非罪犯病变 PCI（实际时间：中位数 1 天），与仅罪犯病变 PCI 相比，完全血运重建可减少 CV 死亡或 MI（HR：0.77；95% 置信区间 [CI]：0.59）到 1.00）。对于计划在出院后进行的非罪犯病变 PCI（实际时间：中位数 23 天），完全血运重建也减少了 CV 死亡或 MI（HR：0.69；95% CI：0.49 至 0.97；交互作用 p = 0.62）。标志性分析表明，前 45 天的 HR 为 0.86（95% CI：0.59 至 1.24）和 0.69（95% CI：0。54 到 0.89) 从 45 天到随访结束，对于预期的非罪犯病变 PCI 与仅罪犯病变 PCI。结论在多支血管病变的 STEMI 患者中，完全血运重建优于单纯 PCI 的益处是一致的，无论研究者确定的非罪犯病变干预时间如何。完全血运重建对硬临床结果的益处主要出现在长期内。