Impact of complete revascularisation in relation to left ventricular function in patients with ST-segment elevation myocardial infarction and multivessel disease: a post hoc analysis of the COMPLETE randomised trial
Authors' conclusion
Among patients presenting with STEMI and MVD, those with reduced LVEF are at higher risk of ischaemic events than patients with preserved LVEF. There is a consistent benefit of complete revascularisation regardless of baseline LVEF.
Study context
- Population
- Patients with STEMI and multivessel disease with baseline left ventricular ejection fraction (LVEF) availableof 4,041 randomised
- Participants
- 2,214 patients
- Comparison
- Complete vs culprit-only revascularisation, by baseline LVEF
- Primary endpoint
- Co-primary: CV death or new MI; CV death, new MI or ischaemia-driven revascularisation
Methodological detailsprespecified LVEF ranges
- Prespecified LVEF ranges
Primary result
As reported in the abstract
CV death or new MI (first co-primary), by LVEF
Complete revascularisation vs Culprit-onlyHazard ratio (95% CI)
LVEF <45% (N=660): 3.0%/yearvs 5.5%/year
0.55(0.36–0.86)
LVEF ≥45% (N=1,554): 2.4%/yearvs 3.2%/year
0.74(0.52–1.04)
Further findings
| Outcome | HR (95% CI) | P value | |
|---|---|---|---|
| CV death, new MI or IDR (second co-primary), by LVEFComplete revascularisationvs Culprit-onlyLVEF <45%: 3.5%/yearvs 7.3%/year | 0.49 (0.33–0.74) | ||
| CV death, new MI or IDR (second co-primary), by LVEFComplete revascularisationvs Culprit-onlyLVEF ≥45%: 2.7%/yearvs 6.3%/year | 0.44 (0.33–0.60) | ||
| CV death or new MI, LVEF <45%vs LVEF ≥45%4.2%/year vs 2.8%/year | 1.51 (1.15–1.98) | P = 0.003 | |
| 0.20.5125Hazard ratio (log scale) |
- Cardiovascular (CV) death, new myocardial infarction (MI) or ischaemia-driven revascularisation (IDR) (second co-primary), by LVEF: interaction p=0.67
Both co-primary outcomes, LVEF ≤35%, 36-49% and ≥50%
- Consistent results across LVEF categories
Original publication
Impact of complete revascularisation in relation to left ventricular function in patients with ST-segment elevation myocardial infarction and multivessel disease: a post hoc analysis of the COMPLETE randomised trial. EuroIntervention. Published 20 October 2025. doi:10.
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