Coronary disease & ACSRandomised controlled trial
Complete or Culprit-Only Percutaneous Coronary Intervention (PCI) in Older Patients with Myocardial Infarction
- Randomised controlled trial
- multicentre
Authors' conclusion
Among patients who were 75 years of age or older with myocardial infarction and multivessel disease, those who underwent physiology-guided complete revascularization had a lower risk of a composite of death, myocardial infarction, stroke, or ischemia-driven revascularization at 1 year than those who received culprit-lesion-only PCI.
Study context
- Population
- Patients ≥75 years with MI and multivessel disease undergoing PCI of the culprit lesion
- Participants
- 1,445 patients
- Comparison
- Physiology-guided complete revascularization vs culprit-only PCI
- Complete revascularizationn = 720
- Culprit-onlyn = 725reference
- Primary endpoint
- Composite of:
- Death
- MI
- Stroke
- Any revascularization
- Follow-up
- 1 year
Primary result
As reported in the abstract
Hazard ratio
0.73
95% CI 0.57–0.93
P = 0.01
Events by treatment group
Complete revascularization vs Culprit-only
HR 0.73 (95% CI 0.57–0.93); P = 0.01
Secondary outcomes
| Outcome | Complete revascularization | Culprit-only | HR (95% CI) | |
|---|---|---|---|---|
| CV death or MI (key secondary) | 8.9% | 13.5% | 0.64 (0.47–0.88) | |
| 0.512Hazard ratio (log scale) |
Safety
Contrast-associated AKI, stroke or bleeding (composite)
- Safety outcome did not appear to differ between the groups (22.5% vs. 20.4%)
- P = 0.37
Original publication
Complete or Culprit-Only PCI in Older Patients with Myocardial Infarction. N Engl J Med. Published 26 August 2023. doi:10.1056/nejmoa2300468
Summarised from the published abstract; every number is checked against it