- Question
- Is it beneficial to treat non-culprit coronary arteries with major stenoses using PCI, in addition to the infarct artery, in patients with ST-segment elevation myocardial infarction (STEMI)?
- Design
- Randomized, open-label trial conducted at five centers in the United Kingdom from 2008 to 2013, enrolling 465 patients. Mean follow-up was 23 months, and the trial was stopped early on the recommendation of the data and safety monitoring committee.
- Population
- Patients with STEMI (including 3 with left bundle-branch block) and multivessel coronary artery disease undergoing PCI of the infarct artery.
- Intervention
- Preventive PCI of non-infarct arteries with major stenoses in addition to infarct-artery PCI (234 patients).
- Control
- PCI limited to the infarct artery with no preventive PCI (231 patients); subsequent PCI for angina was recommended only for refractory angina with objective evidence of ischemia.
- Primary outcome
- Composite of death from cardiac causes, nonfatal myocardial infarction, or refractory angina, analyzed by intention to treat.
- Results
- The primary outcome occurred in 21 patients assigned to preventive PCI and 53 assigned to infarct-artery-only PCI (9 vs. 23 events per 100 patients; HR 0.35; 95% CI 0.21 to 0.58; P<0.001). For the components: cardiac death HR 0.34 (95% CI 0.11 to 1.08), nonfatal myocardial infarction HR 0.32 (95% CI 0.13 to 0.75), and refractory angina HR 0.35 (95% CI 0.18 to 0.69).
- Conclusion
- In patients with STEMI and multivessel coronary disease, preventive PCI of non-infarct arteries with major stenoses significantly reduced adverse cardiovascular events compared with infarct-artery-only PCI.
- Why it matters
- It was one of the first randomized trials to support complete revascularization during the index STEMI hospitalization, challenging the practice of treating only the culprit artery and paving the way for later trials of this strategy.
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 10, 2026