Complete Revascularization in Older Patients With Myocardial Infarction With or Without Complex Nonculprit Lesions
Authors' conclusion
In older patients with MI and multivessel disease, physiology-guided complete revascularization reduced ischemic events, regardless of the complexity of nonculprit lesions.
Study context
- Population
- Older patients with myocardial infarction (MI) and multivessel disease, with (complex subgroup) or without (noncomplex subgroup) ≥1 complex nonculprit lesion641 complex, 804 noncomplex
- Participants
- 1,445 patients
- Comparison
- Complete vs culprit-only revascularization, by nonculprit lesion complexity
- Primary endpoint
- Composite of:
- Death
- MI
- Stroke
- Revascularization
- Follow-up
- 3 years
Methodological detailsprespecified analysis
- Prespecified analysis
Primary result
As reported in the abstract
Primary outcome, by nonculprit lesion complexity (subgroup)
Complete revascularization vs Culprit-onlyHazard ratio (95% CI)
Complex subgroup
0.75(0.56–0.99)
Noncomplex subgroup
0.71(0.53–0.95)
Secondary outcomes
| Outcome | HR (95% CI) | |
|---|---|---|
| Complex vs noncomplex subgroup risk (adjusted) · 3 yearsComplexvs NoncomplexCV death or MI | 1.32 (1.01–1.74) | |
| Complex vs noncomplex subgroup risk (adjusted) · 3 yearsComplexvs NoncomplexMI | 2.33 (1.44–3.78) | |
| Complex vs noncomplex subgroup risk (adjusted) · 3 yearsComplexvs NoncomplexIschemia-driven coronary revascularization | 2.28 (1.46–3.56) | |
| 0.20.5125Hazard ratio (log scale) |
Key secondary outcome (CV death or MI), by lesion complexity
- No evidence of heterogeneity related to nonculprit lesion complexity
Safety
Safety outcome (contrast-associated AKI, stroke, BARC 3 to 5), by lesion complexity
- No evidence of heterogeneity related to nonculprit lesion complexity
Original publication
Complete Revascularization in Older Patients With Myocardial Infarction With or Without Complex Nonculprit Lesions. Circ Cardiovasc Interv. Published 3 October 2025. doi:10.
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