A Randomized Trial of Complete Versus Culprit‐Only Revascularization During Primary Percutaneous Coronary Intervention in Diabetic Patients With Acute ST Elevation Myocardial Infarction and Multi Vessel Disease

Background

Recent randomized trials and meta‐analyses demonstrated that a complete revascularization of significant non culprit lesions in patients with ST elevation myocardial infarction (STEMI) is superior to a culprit only revascularization approach in reducing major adverse cardiac events (MACE), however the proportion of diabetic patients was low in these trials.

Objectives

To investigate whether a complete revascularization approach is associated with better outcomes in diabetic patients with STEMI and multi‐vessel disease.

Methods

One hundred diabetic patients with acute STEMI with at least one non‐culprit lesion were randomized to either complete revascularization (n = 50) or culprit‐only treatment (n = 50). Complete revascularization was performed either at the time of primary percutaneous coronary intervention (PCI) or within 72 hours during hospitalization. The primary endpoint was the composite of all‐cause mortality, recurrent MI, and ischemia‐driven revascularization at 6 months.

Results

A complete revascularization approach was significantly associated with a reduction in the primary outcome (6% vs. 24%, P = 0.01), primarily due to reduction in ischemia driven revascularization in the complete revascularization group (2% vs. 12%; P = 0.047). There was no significant reduction in death or MI (2% vs. 8%; P = 0.17) and (2% vs. 4%; P = 0.56) respectively, or in the safety endpoints of major or minor bleeding, contrast‐induced nephropathy, or stroke between the groups.

Conclusions

In diabetic patients with multi‐vessel coronary artery disease undergoing PPCI, complete revascularization is associated with significantly reduced risk of adverse cardiovascular events, as compared with culprit vessel only PCI. (J Interven Cardiol 2016;29:241–247)