- Question
- To determine whether, in patients with ST-segment elevation myocardial infarction (STEMI) and multivessel coronary disease, also revascularizing nonculprit lesions improves outcomes compared with treating the culprit lesion alone.
- Design
- Randomized, single-masked trial enrolling 4042 patients with STEMI and multivessel disease after successful culprit-lesion PCI. Randomization was stratified by the intended timing of nonculprit-lesion PCI (during or after the index hospitalization). Median follow-up was 3 years.
- Population
- Patients with STEMI and multivessel coronary artery disease who had already undergone successful culprit-lesion PCI.
- Intervention
- Complete revascularization with PCI of angiographically significant nonculprit lesions, in addition to optimal medical therapy.
- Control
- No further revascularization (culprit-lesion-only PCI), with optimal medical therapy.
- Primary outcome
- Two coprimary outcomes: (1) composite of cardiovascular death or myocardial infarction; (2) composite of cardiovascular death, myocardial infarction, or ischemia-driven revascularization.
- Results
- The first coprimary outcome occurred in 158 of 2016 patients (7.8%) with complete revascularization versus 213 of 2025 (10.5%) with culprit-lesion-only PCI (HR 0.74; 95% CI 0.60 to 0.91; P = 0.004). The second coprimary outcome occurred in 179 patients (8.9%) versus 339 (16.7%) (HR 0.51; 95% CI 0.43 to 0.61; P<0.001).
- Conclusion
- In patients with STEMI and multivessel disease, complete revascularization was superior to culprit-lesion-only PCI in reducing both coprimary outcomes, with consistent benefit regardless of the intended timing of nonculprit-lesion PCI.
- Why it matters
- It provided strong evidence supporting routine revascularization of significant nonculprit lesions in STEMI with multivessel disease, and showed that the timing of the procedure (during or after the index hospitalization) does not change the benefit.
Card generated automatically with AI from the abstract of the original publication and the trial registry; every figure was checked against those sources. It may contain errors: verify the data at the source before using it for clinical decisions.
Generated on October 7, 2026