Complete revascularization may improve angina-related health in STEMI, multivessel CAD – Healio

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Mehta SR, et al. Featured Clinical Research I. Presented at: American College of Cardiology Scientific Session; April 2-4, 2022; Washington, D.C. (hybrid meeting).
Mehta SR, et al. Featured Clinical Research I. Presented at: American College of Cardiology Scientific Session; April 2-4, 2022; Washington, D.C. (hybrid meeting).
WASHINGTON — Complete revascularization, as opposed to culprit lesion-only revascularization, was associated with better angina-related quality of life in patients with STEMI and multivessel CAD, a speaker reported.
At the American College of Cardiology Scientific Session, Shamir R. Mehta, MD, MSc, FRCPC, FACC, FESC, director of interventional cardiology at Hamilton Health Services and professor in the division of cardiology at McMaster University in Hamilton, Ontario, Canada, reported the findings of a prespecified analysis of the COMPLETE trial.
“In patients with STEMI and multivessel disease, both a complete and culprit lesion-only strategy improved angina-related quality of life compared with baseline, but at a median of 3 years follow-up, more patients were free of angina in the complete revascularization group than the culprit lesion-only group,” Mehta said during the presentation, “The benefit was observed almost entirely in patients with tight nonculprit lesions with stenosis severity greater than or equal to 80%, and total angina burden from randomization to follow-up was substantially reduced.”
The main COMPLETE study was a multinational, randomized trial including more than 4,000 patients who presented with STEMI multivessel CAD who underwent complete or culprit lesion-only revascularization within 72 hours after successful culprit-lesion PCI.
As Healio previously reported, complete revascularization was superior to culprit lesion-only PCI for lowering risk for CV death or MI in this patient population.
Mehta said the results of the COMPLETE trial resulted in complete revascularization being labeled as a class 1A recommendation for concomitant STEMI and multivessel CAD in the 2021 ACC/American Heart Association/American Association for Thoracic Surgery/Society of Thoracic Surgeons/Society for Cardiovascular Angiography and Interventions Guideline for Coronary Artery Revascularization.
For the present analysis of the COMPLETE data, Mehta and colleagues evaluated the effects of complete revascularization compared with culprit lesion-only PCI on patients’ angina-related quality of life.
To this end, researchers utilized responses to the Seattle Angina Questionnaire, a 19-item questionnaire, which was administered at baseline, 6 months and final visit (median, 3 years). The primary outcome was Seattle Angina Questionnaire score as a continuous variable and the proportion of patients free from angina symptoms. Scoring was gauged on a scale of 0 to 100, with 100 meaning a patient was free from angina.
At the end of the COMPLETE trial, 87.5% of individuals who underwent complete revascularization and 84.3% of those who received culprit lesion-only revascularization were free from angina by their final visit (absolute difference = 3.2 percentage points; 95% CI, 0.7-5.7).
Mehta reported that this finding translated to a number needed to treat of 31 to prevent one patient from experiencing angina by their final visit (P = .013).
Angina-related benefits were primarily observed among patients with nonculprit stenosis of 80% or more visual and 60% or more lab core (P for interaction = .017).
Moreover, at trial end, the composite endpoint of new MI, ischemia-driven revascularization, unstable angina or residual angina was lower among patients who underwent complete compared with culprit lesion-only revascularization (P < .001).
“The implications of this are that complete revascularization improves overall patient-reported health status in addition to its already established benefit in reducing major cardiovascular events,” Mehta said during the presentation. “These data also provide new information for patients and physicians to consider in the context of shared decision-making, which is also a class I recommendation in the new revascularization guidelines as it relates to coronary artery revascularization in patients with STEMI.”
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