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COMPLETE Trial Non-culprit PCI — EECC MCQ

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ModerateCoronary Artery DiseaseCOMPLETE Trial Non-culprit PCIEECC

A 68-year-old woman with multivessel NSTEMI undergoes angiography showing a culprit lesion in the RCA and non-culprit lesions in the LAD and LCx. The COMPLETE trial is discussed. What did it show?

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Correct answer: C — COMPLETE showed that complete revascularisation of all significant non-culprit lesions (staged PCI during the index admission or within 45 days) reduced cardiovascular death and MI compared with culprit-only PCI in STEMI patients — this supports treating all significant lesions, not just the culprit

The COMPLETE trial (2019) randomised 4,041 STEMI patients with multivessel disease (successful culprit-lesion PCI + ≥1 non-culprit lesion with ≥70% stenosis or FFR ≤0.80) to: complete revascularisation (staged PCI of non-culprit lesions) vs culprit-only PCI. Results: complete revascularisation reduced the composite of CV death or new MI by 26% (HR 0.74, driven by MI reduction). This was consistent whether staged PCI was performed during the index admission or within 45 days. The 2023 ESC ACS Guidelines now recommend: (1) complete revascularisation in STEMI patients with multivessel disease (Class I); (2) staged PCI during the index hospitalisation or as an early outpatient procedure; (3) for NSTEMI: complete revascularisation is also recommended (Class IIa) based on extrapolation and the BIOVASC trial.

Reference: ESC (2023): ACS Guidelines; COMPLETE Trial