A NOVEL sub-study of the COMPLETE trial has revealed that complete revascularisation improves angina-related quality of life (QoL) in patients with ST-segment elevation myocardial infarction (STEMI) and multivessel coronary artery disease (CAD). The pioneering COMPLETE trial, published in 2019, showed that complete revascularisation reduced cardiovascular death and new myocardial infarction; however, its impact on angina-related QoL remained unclear.
In this follow-up sub-study, presented at the American College of Cardiology Annual Scientific Session (ACC 2022), Shamir Mehta, Chair in Interventional Cardiology, Population Health Research Institute, McMaster University, and Director of the Interventional Cardiology Program, Hamilton Health Sciences, Ontario, Canada, and colleagues analysed the results from the patient-reported Seattle Angina Questionnaire (SAQ). The trial included 4,041 patients with STEMI and CAD who were randomised to complete revascularisation (n=2,016) or culprit-only revascularisation (n=2,025). Patients who were assigned to complete revascularisation underwent primary percutaneous coronary intervention during or immediately following hospitalisation.
Over the course of a 3-year follow-up study, patients were administered the SAQ at baseline, at 6 months, and at a final visit to assess their frequency of angina, physical limitation, treatment satisfaction, and QoL. At the end of the study, the researchers found that the scores in the complete revascularisation versus culprit-only revascularisation groups were as follows: angina frequency: 9.8 versus 8.6 (P=0.006); physical limitation: 4.2 versus 4.3 (p=0.018); treatment satisfaction: 0.6 versus 0.2 (p=-0.028); QoL: 16.3 versus 15.9 (p=0.048); summary score: 9.8 versus 9.6 (p=0.003). Overall, complete revascularisation was demonstrated to be more beneficial among patients with STEMI and CAD compared with culprit-only revascularisation.
Commenting on the outcomes of the trial, Mehta stated: “Complete revascularisation improves overall patient-reported health status, in addition to its established benefit in reducing major cardiovascular events.” Mehta concluded that “these data also provide important new information for physicians to consider in the context of shared decision-making, as it relates to coronary artery revascularisation in patients with STEMI.”