Completeness of revascularization in relation to major cardiovascular events in patients with ST-elevation myocardial infarction and multivessel disease: results from the COMPLETE trial
Bibliographic record
Abstract
Abstract Background In the COMPLETE trial (Complete versus Culprit-Only Revascularization Strategies to Treat Multivessel Disease after Early Percutaneous Coronary Intervention for ST-Segment Elevation Myocardial Infarction), a multivessel percutaneous coronary intervention (PCI) strategy was superior to culprit-only PCI in reducing ischemic events in patients with ST-elevation myocardial infarction (STEMI) and multivessel disease (MVD). Purpose To evaluate whether the completeness of revascularisation influences the effect of multivessel PCI versus culprit-lesion only revascularization among patients with STEMI and MVD based on a modified residual SYNTAX score (R’SS). Methods The COMPLETE trial randomized 4,041 patients with STEMI and MVD to either angiography-guided, staged multivessel PCI of all non-culprit lesions (NCLs)> 70% stenosis or a culprit lesion-only strategy. An angiographic core lab evaluated all baseline and follow-up coronary angiograms for completeness of revascularization as assessed by the R’SS after NCL-PCI in the multivessel PCI group. A R’SS=0 indicated complete revascularization of all NCL’s with≥70% stenosis and a R’SS>0 indicated incomplete revascularization with≥1 eligible NCLs not revascularized. The first coprimary outcome was cardiovascular death (CV-death) or new myocardial infarction (MI) and the second coprimary outcome was CV-death, new MI, or ischemia-driven revascularization. Results In the multivessel PCI group, 90% achieved complete revascularization (R'SS=0), while 10% did not (R'SS>0). There were no major differences in baseline characteristics between the culprit lesion-only group, the multivessel PCI R’SS=0 and R’SS>0 groups. Among patients in the multivessel PCI group achieving a R’SS=0, the first coprimary outcome occurred less frequently compared with those who underwent culprit lesion-only PCI (6.6% vs. 10.7%, HR 0.61 [0.48-0.77]). By contrast, among those with a R’SS>0, there was no difference in the first coprimary outcome compared with the culprit lesion-only PCI group (10.7% vs. 10.7%, HR 0.98 [0.61-1.57], interaction P<0.001). Similarly, the second coprimary outcome was less common in the R’SS=0 group compared with the culprit lesion-only PCI group (7.4% vs. 17.1%, HR 0.41 [0.33-0.51], whereas no difference was observed in patients with a R’SS>0 and the culprit-only PCI group (HR 0.67 [0.43-1.04], interaction P<0.001), (Figure 1&2). Conclusions Among patients with STEMI and MVD randomized to a multivessel PCI strategy, those achieving complete revascularization as assessed in an angiographic core lab, experienced a significant reduction in major cardiovascular events compared with a culprit lesion-only strategy. By contrast, in patients randomized to a multivessel PCI strategy where complete revascularization was not achieved, no such benefit was observed. This finding implies that the benefit of multivessel PCI is dependent on actually achieving complete revascularization.Figure 1 Figure 2
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.005 | 0.008 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.002 | 0.003 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".