Complete versus culprit lesion-only revascularisation for acute myocardial infarction (Complete Revascularisation Trialists' Collaboration): an individual patient data meta-analysis of randomised trials
Authors' conclusion
In patients presenting with acute myocardial infarction and multivessel disease, complete revascularisation reduced the composite of cardiovascular death or new myocardial infarction as well as cardiovascular death alone compared with a culprit lesion-only PCI strategy. In addition, all-cause death was lower with complete revascularisation.
Study context
- Population
- Patients with acute STEMI or NSTEMI and multivessel CAD
- Participants
- 8,836 patients6 RCTs
- Comparison
- Complete revascularisation vs culprit lesion-only percutaneous coronary intervention (PCI)
- Complete revascularisationn = 4,259
- Culprit lesion-onlyn = 4,577reference
- Outcome
- Composite of:
- Cardiovascular death or new myocardial infarction
- Cardiovascular death alone
Methodological detailsone-stage IPD meta-analysis (Cox frailty model), hierarchical testing
- One-stage IPD meta-analysis (Cox frailty model)
- Hierarchical testing
Pooled result
As reported in the abstract
median follow-up 36.0 months (IQR 30.6-48.0)
Complete revascularisation
- CV death or new MI
- 382 (9.0%) of 4259
- CV death
- 155 (3.6%)
Culprit lesion-only
- CV death or new MI
- 528 (11.5%) of 4577
- CV death
- 209 (4.6%)
CV death or new MI
Complete revascularisation382 (9.0%) of 4259
Culprit lesion-only528 (11.5%) of 4577
CV death
Complete revascularisation155 (3.6%)
Culprit lesion-only209 (4.6%)
Complete revascularisation vs Culprit lesion-onlyHazard ratio (95% CI)P value
CV death or new MI
0.76(0.67–0.87)
P < 0.0001CV death
0.76(0.62–0.93)
P = 0.0091Further pooled results
| Outcome | Complete revascularisation | Culprit lesion-only | HR (95% CI) | P value | |
|---|---|---|---|---|---|
| All-cause death | 7.2% | 8.1% | 0.85 (0.73–0.99) | P = 0.039 | |
| Non-CV death | 3.6% | 3.5% | 0.98 (0.78–1.22) | P = 0.85 | |
| New MI | 6.0% | 7.8% | 0.76 (0.65–0.90) | P = 0.0011 | |
| 0.512Hazard ratio (log scale) |
Original publication
Complete versus culprit lesion-only revascularisation for acute myocardial infarction (Complete Revascularisation Trialists' Collaboration): an individual patient data meta-analysis of randomised trials. Lancet. Published 9 November 2025. doi:10.
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