- Question
- In patients with STEMI and multivessel disease undergoing primary PCI, does complete revascularization during the index admission improve clinical outcomes compared with treating only the infarct-related artery?
- Design
- Open-label randomized trial conducted at 7 U.K. centers, enrolling 296 patients allocated through an interactive voice-response system. Randomization was stratified by infarct location (anterior/nonanterior) and symptom onset (≤3 h or >3 h). Follow-up was 12 months.
- Population
- Patients presenting for primary PCI for ST-segment elevation myocardial infarction who were found on angiography to have multivessel disease.
- Intervention
- Complete revascularization during the index admission (150 patients), performed at the time of primary PCI or before hospital discharge.
- Control
- Revascularization of the infarct-related artery only (146 patients).
- Primary outcome
- Composite of all-cause death, recurrent myocardial infarction, heart failure and ischemia-driven revascularization at 12 months.
- Results
- The primary endpoint occurred in 10.0% of the complete revascularization group versus 21.2% of the infarct-related artery-only group (HR 0.45; 95% CI 0.24 to 0.84; p = 0.009). There was no significant reduction in death or MI, although all components of the primary endpoint showed a nonsignificant reduction.
- Safety
- There were no differences between groups in major bleeding, contrast-induced nephropathy or stroke. No reduction in ischemic burden was seen on myocardial perfusion scintigraphy.
- Conclusion
- Complete revascularization during the index admission lowered the composite endpoint at 12 months compared with treating only the infarct-related artery, without showing a benefit on mortality by itself.
- Why it matters
- It provided early evidence supporting treatment of non-culprit lesions during the index admission in STEMI patients with multivessel disease, helping to shift practice and prompting larger trials to assess the effect on survival.
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 18, 2026