Complete Revascularization Not Superior to Culprit-Only PCI After MI

In patients with ST-elevation myocardial infarction and multivessel disease, fractional flow reserve -guided complete nonculprit revascularization did not reduce death, myocardial infarction or unplanned revascularization compared with culprit lesion-only percutaneous coronary intervention .

The primary outcome was a composite of death from any cause, MI, or unplanned revascularization. Secondary outcomes included a composite of death from any cause or MI and unplanned revascularization. At a median follow-up of 4.8 years, a primary-outcome event had occurred in 145 patients in the complete-revascularization group and in 159 in the culprit lesion-only group or unplanned revascularization .

Results for the primary outcome appeared to be consistent across subgroups, including age, diabetes, nonculprit stenosis grade on visual estimation, and the presence of a nonculprit lesion in the proximal left anterior descending coronary artery.The findings prompted several questions from panelist William Fearon, MD, a professor at Stanford University School of Medicine, California.

Fearon then asked why all-cause death was chosen as a primary endpoint for the trial instead of cardiovascular death."Was there a reason to choose all-cause? For example, because it was a registry-based trial and easier to adjudicate?" Vijay Kunadian, MD, of Newcastle University and Cardiothoracic Centre, Freeman Hospital, Newcastle Upon Tyne Hospitals NHS Foundation Trust, United Kingdom, also raised several issues in an

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