Complete Revascularization with Multivessel PCI for Myocardial Infarction

作者：Shamir R. Mehta, David Wood, Robert F. Storey, Roxana Mehran, Kevin R. Bainey, Helen Nguyen, Brandi Meeks, Giuseppe Di Pasquale, José López-Sendón, David P. Faxon, Laura Mauri, Sunil V. Rao, Laurent J. Feldman, Philippe Gabríel Steg, Álvaro Avezum, Tej Sheth, Natalia Pinilla‐Echeverri, Raúl Moreno, Gianluca Campo, Benjamin Wrigley, Saško Kedev, Andrew G.C. Sutton, Richard Oliver, Josep Rodés‐Cabau, Goran Stanković, Robert C. Welsh, Shahar Lavi, Warren J. Cantor, Jia Wang, Juliet Nakamya, Shrikant I. Bangdiwala, John A. Cairns · 发表于：New England Journal of Medicine · 年份：2019 · DOI：10.1056/nejmoa1907775 · 被引用次数：925 · 研究领域：Coronary Interventions and Diagnostics、Acute Myocardial Infarction Research、Antiplatelet Therapy and Cardiovascular Diseases

BACKGROUND: In patients with ST-segment elevation myocardial infarction (STEMI), percutaneous coronary intervention (PCI) of the culprit lesion reduces the risk of cardiovascular death or myocardial infarction. Whether PCI of nonculprit lesions further reduces the risk of such events is unclear. METHODS: We randomly assigned patients with STEMI and multivessel coronary artery disease who had undergone successful culprit-lesion PCI to a strategy of either complete revascularization with PCI of angiographically significant nonculprit lesions or no further revascularization. Randomization was stratified according to the intended timing of nonculprit-lesion PCI (either during or after the index hospitalization). The first coprimary outcome was the composite of cardiovascular death or myocardial infarction; the second coprimary outcome was the composite of cardiovascular death, myocardial infarction, or ischemia-driven revascularization. RESULTS: At a median follow-up of 3 years, the first coprimary outcome had occurred in 158 of the 2016 patients (7.8%) in the complete-revascularization group as compared with 213 of the 2025 patients (10.5%) in the culprit-lesion-only PCI group (hazard ratio, 0.74; 95% confidence interval [CI], 0.60 to 0.91; P = 0.004). The second coprimary outcome had occurred in 179 patients (8.9%) in the complete-revascularization group as compared with 339 patients (16.7%) in the culprit-lesion-only PCI group (hazard ratio, 0.51; 95% CI, 0.43 to 0.61; P<0.001...