In the COMPLETE trial design for patients with STEMI and multivessel coronary artery disease, what was the primary finding regarding complete revascularisation vs. culprit-only PCI?
- A Culprit-only PCI reduced in-hospital complications without affecting long-term MACE
- B Complete revascularisation was only beneficial if done in the same sitting as primary PCI
- C Complete revascularisation reduced cardiovascular death and myocardial infarction at 3 years ✓
- D Both strategies produced similar 1-year outcomes, favouring staged approach only in elderly
Correct answer: C. Complete revascularisation reduced cardiovascular death and myocardial infarction at 3 years
Explanation
The COMPLETE trial (NEJM 2019) randomised 4041 STEMI patients with multivessel CAD to complete revascularisation vs. culprit-only PCI. Complete revascularisation (done staged, within 45 days) significantly reduced the composite of cardiovascular death or new MI at a median 3-year follow-up (7.8% vs. 10.5%), driven by a reduction in new MI. The benefit was irrespective of haemodynamic status or timing. This established guideline support (ACC/AHA 2021, ESC 2023) for staged complete revascularisation in haemodynamically stable STEMI with multivessel disease.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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