Left Anterior Descending Nonculprit Lesions and Clinical Outcomes in Patients With ST-Segment Elevation Myocardial Infarction

Brian P McGrath; Natalia Pinilla-Echeverri; David A Wood; Kevin R Bainey; Tej Sheth; Erick Schampaert; Jean-Francois Tanguay; Vladimír Džavík; Robert F Storey; Roxana Mehran; Matthias Bossard; Raul Moreno; Gianluca Campo; Sunil V Rao; Warren J Cantor; Shahar Lavi; Peter V Johnston; Vincenzo Guiducci; Hahn Hoe Kim; Thenmozhi Mani; Helen Nguyen; John A Cairns; Shamir R Mehta

doi:10.1016/j.jcin.2024.09.004

Left Anterior Descending Nonculprit Lesions and Clinical Outcomes in Patients With ST-Segment Elevation Myocardial Infarction

JACC Cardiovasc Interv. 2024 Oct 30:S1936-8798(24)01171-3. doi: 10.1016/j.jcin.2024.09.004. Online ahead of print.

Authors

Brian P McGrath¹, Natalia Pinilla-Echeverri¹, David A Wood², Kevin R Bainey³, Tej Sheth¹, Erick Schampaert⁴, Jean-Francois Tanguay⁵, Vladimír Džavík⁶, Robert F Storey⁷, Roxana Mehran⁸, Matthias Bossard⁹, Raul Moreno¹⁰, Gianluca Campo¹¹, Sunil V Rao¹², Warren J Cantor¹³, Shahar Lavi¹⁴, Peter V Johnston¹⁵, Vincenzo Guiducci¹⁶, Hahn Hoe Kim¹⁷, Thenmozhi Mani¹, Helen Nguyen¹, John A Cairns², Shamir R Mehta¹⁸

Affiliations

¹ Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada.
² Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, British Columbia, Canada.
³ Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada.
⁴ Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Montreal, Quebec, Canada.
⁵ Montreal Heart Institute and Université de Montréal, Montreal, Quebec, Canada.
⁶ Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada.
⁷ Division of Clinical Medicine, University of Sheffield, Sheffield, United Kingdom.
⁸ The Zena A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
⁹ Cardiology Division, Heart Center-Luzerner Kantonsspital, Luzern, Switzerland.
¹⁰ Hospital Universitario La Paz, Universidad Autónoma de Madrid, Instituto de Investigacion Hospital Universitario La Paz Research Institute, Madrid, Spain.
¹¹ Azienda Ospedaliero Universitaria di Ferrara, University of Ferrara, Ferrara, Italy.
¹² New York University Langone Health System, New York, USA.
¹³ Southlake Regional Health Centre, University of Toronto, Toronto, Ontario, Canada.
¹⁴ Western University, London Health Sciences Centre, London, Ontario, Canada.
¹⁵ Johns Hopkins Hospital, Baltimore, Maryland, USA.
¹⁶ Cardiology Unit, Azienda USL-IRCCS Reggio Emilia, S. Maria Nuova Hospital, Reggio Emilia, Italy.
¹⁷ St. Mary's Hospital Kitchener, Ontario, Canada.
¹⁸ Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada. Electronic address: smehta@mcmaster.ca.

PMID: 39641724
DOI: 10.1016/j.jcin.2024.09.004

Abstract

Background: In the COMPLETE (Complete vs Culprit-Only Revascularization to Treat Multi-Vessel Disease After Early PCI for STEMI) trial, complete revascularization in patients with ST-segment elevation myocardial infarction (STEMI) and multivessel disease (MVD) reduced important outcomes compared with culprit-only percutaneous coronary intervention. Whether clinical outcomes in STEMI patients with MVD are influenced by the presence of a left anterior descending (LAD) nonculprit lesion (NCL) remains unknown.

Objectives: This study sought to compare: 1) cardiovascular outcomes among patients with an NCL in the proximal/mid-LAD to patients with an NCL in other locations; and 2) the benefit of NCL revascularization in patients with and without a proximal/mid-LAD NCL.

Methods: The COMPLETE trial enrolled patients presenting with STEMI and MVD to angiography-guided complete revascularization vs a culprit lesion-only strategy. All coronary angiograms were evaluated in a central core laboratory. In this prespecified subanalysis, treatment effect according to proximal/mid-NCL location was determined for the coprimary outcomes of: 1) cardiovascular death or new myocardial infarction; and 2) cardiovascular death, new myocardial infarction, or ischemia-driven revascularization. Cox proportional hazards models were performed with an interaction term for treatment allocation and NCL location.

Results: Of the 4,041 subjects in COMPLETE, 1,666 patients had a proximal/mid-LAD NCL (41.2%). The first coprimary outcome occurred in 8.5% (2.9%/y) of patients with a proximal/mid-LAD NCL vs 9.9% (3.4%/y) in those without (adjusted HR: 0.83; 95% CI: 0.67-1.03). Complete revascularization had a similar benefit in reducing the first coprimary outcome for patients with a proximal/mid-LAD NCL (7.7% vs 9.2%; HR: 0.85; 95% CI: 0.61-1.18) and those without (8.0% vs 11.9%; HR: 0.65; 95% CI: 0.50-0.86), with no differential treatment effect (interaction P = 0.235) CONCLUSIONS: Among patients presenting with STEMI and multivessel CAD, those with a proximal/mid-LAD NCL had similar event rates to those without. The benefit of complete revascularization between the groups was similar, with no evidence of heterogeneity.

Keywords: ST-segment elevation myocardial infarction; left anterior descending; multivessel coronary artery disease; percutaneous coronary intervention; revascularization.