Effects of complete revascularization according to age in patients with ST-segment elevation myocardial infarction and multivessel disease (COMPLETE-AGE) - 07/12/23

Doi : 10.1016/j.ahj.2023.10.004

Kevin R. Bainey, MD, MSc ^a, David A. Wood, MD ^b, Matthias Bossard, MD ^c, Gianluca Campo, MD ^d, Warren J. Cantor, MD ^e, Shahar Lavi, MD ^f, Mina Madan, MD ^g, Roxana Mehran, MD ^h, Natalia Pinilla-Echeverri, MD ⁱ, Sunil Rao, MD ^j, Jaydeep Sarma, MA, PhD, FRCP ^k, Tej Sheth, MD ⁱ, Goran Stankovic, MD ^l, Phillipe Gabriel Steg, MD ^m, Robert F. Storey, MD ⁿ, Jean-Francois Tanguay, MD ^o, James L. Velianou, MD ^p, Robert C. Welsh, MD ^a, Thenmozhi Mani, PhD ⁱ, John A. Cairns, MD ^b, Shamir R. Mehta, MD, MSc ^i,^⁎
for the
COMPLETE trial investigators
^a Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada
^b University of British Columbia, Vancouver, British Columbia, Canada
^c Luzerner Kantonsspital, Luzern, Switzerland
^d Azienda Ospedaliero Universitaria di Ferrara, University of Ferrara, Ferrara, Italy
^e Southlake Regional Health Centre, University of Toronto, Toronto, Ontario, Canada
^f Western University, London Health Sciences Centre, London, Ontario, Canada
^g Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
^h The Zena A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY
ⁱ Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
^j NYU Langone Health System, New York, NY
^k North West Heart Centre, Wythenshawe Hospital, Manchester, United Kingdom
^l University Clinical Center of Serbia and Faculty of Medicine, University of Belgrade, Belgrade, Serbia
^m Hôpital Bichat, Paris, France
ⁿ Department of Infection, Immunity, and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
^o Montreal Heart Institute and Universite de Montreal, Montreal, Quebec, Canada
^p McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada

^⁎Reprint requests: Shamir R. Mehta MD, MSc, McMaster University and Hamilton Health Sciences, Population Health Research Institute, David Braley Research Building, Hamilton General Hospital, 237 Barton St E. Hamilton, Ontario, Canada L8L2X2.McMaster University and Hamilton Health SciencesPopulation Health Research InstituteDavid Braley Research Building, Hamilton General Hospital, 237 Barton St E. HamiltonOntarioL8L2X2Canada

ABSTRACT

Background

In ST-segment elevation myocardial infarction (STEMI), complete revascularization with percutaneous coronary intervention (PCI) reduces major cardiovascular events compared with culprit-lesion-only PCI. Whether age influences these results remains unknown.

Methods

COMPLETE was a multinational, randomized trial evaluating a strategy of staged complete revascularization, consisting of angiography-guided PCI of all suitable nonculprit lesions, versus a strategy of culprit-lesion-only PCI. In this prespecified subgroup analysis, treatment effect according to age (≥65 years vs <65 years) was determined for the first coprimary outcome of cardiovascular (CV) death or new myocardial infarction (MI) and the second coprimary outcome of CV death, new MI, or ischemia-driven revascularization (IDR). Median follow-up was 35.8 months (interquartile range [IQR]: 27.6-44.3 months).

Results

Of 4,041 patients randomized in COMPLETE, 1,613 were aged ≥ 65 years (39.9%). Higher event rates were observed for both coprimary outcomes in patients aged ≥ 65 years comparted with those aged < 65 years (11.2% vs 7.9%, HR 1.49, 95% CI 1.22-1.83; 14.4% vs 11.8%, HR 1.28, 95% CI 1.07-1.52, respectively). Complete revascularization reduced the first coprimary outcome in patients ≥ 65 years (9.7% vs 12.5%, HR 0.77; 95% CI, 0.58-1.04) and < 65 years (6.7% vs 9.1%, HR 0.72; 95% CI, 0.54-0.96)(interaction P = .74). The second coprimary outcome was reduced in those ≥ 65 years (HR 0.56, 95% CI, 0.43-0.74) and < 65 years (HR 0.48, 95% CI, 0.37-0.61 (interaction P = .37). A sensitivity analysis was performed with consistent results demonstrated using a 75-year threshold (albeit attenuated).

Conclusions

In patients with STEMI and multivessel CAD, complete revascularization compared with culprit-lesion-only PCI reduced major cardiovascular events regardless of patient age and could be considered as a revascularization strategy in older adults.

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Effects of complete revascularization according to age in patients with ST-segment elevation myocardial infarction and multivessel disease (COMPLETE-AGE) - 07/12/23

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