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COMPLETE study in NEJM and at ESC 2019

The findings of the COMPLETE revascularization with multivessel PCI for myocardial infarction were published September 1, 2019 in the  New England Journal of Medicine (NEJM), showing that opening all clogged arteries with stents after a serious heart attack is much better than opening only the single clogged artery that caused the heart attack. Dr. Shamir Mehta, PI on COMPLETE, presented the findings as a late-breaking science session at the European Society of Cardiology (ESC) Congress 2019 in Paris, France on September 1st.

About half of all heart attack victims are found to have additional clogged arteries in addition to the one that caused their heart attack. Previously, doctors focused on opening the one artery responsible for the heart attack, leaving the other blockages for treatment with medication alone. The new study, a collaboration of 130 hospitals in 31 countries, has shown that opening all the blockages is better than treating only the one blockage causing the heart attack. This led to a 26% reduction in the patient’s risk of dying or having a recurrent heart attack.

“Given its large size, international scope and focus on patient-centered outcomes, the COMPLETE trial will change how doctors treat this condition and prevent many thousands of recurrent heart attacks globally every year,” said Mehta, who is the Senior Scientific Program Lead, ACS and Interventional Cardiology, PHRI. “The benefits emerged over the long term and were similar when the additional stent procedures were done anytime in the first 45 days after the heart attack.”

Over the median of three years, a second heart attack or cardiovascular death dropped to 7.8% of the patients who had the complete revascularization compared to 10.5% of those who had a stent only for the artery that caused the first heart attack, a highly significant difference, said Mehta. The benefit was even more sizable when factoring in other untoward events such as severe chest pain necessitating a repeat stenting procedure.

The COMPLETE study, led by PHRI and funded by the Canadian Institutes of Health Research, involved 4,041 patients and is the first large, randomized, international trial to show a reduction in major outcomes with this approach.