Browse by author
Lookup NU author(s): Professor Vijay KunadianORCiD
Full text for this publication is not currently held within this repository. Alternative links are provided below where available.
© 2026 American Heart Association, Inc. BACKGROUND: – Complete revascularization is superior to culprit lesion–only percutaneous coronary intervention (PCI) in reducing ischemic events in patients with ST-segment–elevation myocardial infarction and multivessel disease. However, the relationship between the extent of revascularization and the benefits of a complete revascularization strategy remains unclear. The aim of this substudy of the COMPLETE trial was to evaluate how the degree of anatomic completeness of revascularization, measured by the core laboratory-derived modified residual SYNTAX score (R′SS), relates to major cardiovascular events. METHODS: – We conducted an exploratory post hoc analysis of the COMPLETE trial (n=3738), stratifying patients randomized in the complete revascularization group based on the R′SS assessed after staged nonculprit lesion–PCI. Complete revascularization was defined by an R′SS=0, whereas incomplete revascularization was defined by an R′SS>0. A stratified Cox proportional hazards model was used, with the culprit-only PCI arm designated as the reference group for comparison. The first coprimary outcome was a composite of cardiovascular death or new myocardial infarction. The second coprimary outcome was a composite of cardiovascular death, new myocardial infarction, or ischemia-driven revascularization. RESULTS: – Among patients randomized to a complete revascularization strategy, 90% achieved complete revascularization (R′SS=0), whereas 10% did not (R′SS>0). In patients with R′SS=0, the first coprimary outcome occurred less frequently (6.6%) compared with those randomized to the culprit lesion–only PCI strategy (10.7%; adjusted hazard ratio, 0.61 [95% CI, 0.47–0.78]). Among patients with an R′SS>0, the first coprimary outcome was similar (10.7%) to those in the culprit lesion–only PCI group (10.7%; adjusted hazard ratio, 1.01 [95% CI, 0.61–1.67]). A similar result was observed for the second coprimary outcome. CONCLUSIONS: – This exploratory analysis of the COMPLETE trial suggests that the benefit of a complete revascularization strategy in patients with ST-segment–elevation myocardial infarction and multivessel disease may be related to the extent of anatomic completeness of revascularization. REGISTRATION: – URL: https://www.clinicaltrials.gov; Unique identifier: NCT01740479.
Author(s): Madanchi M, Pinilla-Echeverri N, Wood DA, Sheth T, Storey RF, Kunadian V, Campo G, Moreno R, Mehran R, Rao SV, Bainey KR, Cieza T, Nguyen H, Mani T, Cairns JA, Mehta SR
Publication type: Article
Publication status: Published
Journal: Circulation: Cardiovascular Interventions
Year: 2026
Pages: Epub ahead of print
Online publication date: 03/06/2026
Acceptance date: 14/05/2026
ISSN (print): 1941-7640
ISSN (electronic): 1941-7632
Publisher: Lippincott Williams and Wilkins
URL: https://doi.org/10.1161/CIRCINTERVENTIONS.126.016515
DOI: 10.1161/CIRCINTERVENTIONS.126.016515
PubMed id: 42233186
Altmetrics provided by Altmetric
