Novel approaches to guide complete revascularisation in patients with STEMI and multivessel coronary artery disease

Primary percutaneous coronary intervention is the preferred method of reperfusion in patients with ST-segment elevation myocardial infarction (STEMI). These patients often have multivessel coronary artery disease (CAD), which carries a much worse prognosis than patients with single-vessel disease. Recently, the COMPLETE trial definitively established the benefit of a complete revascularisation strategy in patients with STEMI and multivessel CAD1. At a median follow-up of three years, complete revascularisation reduced cardiovascular (CV) death or new myocardial infarction (MI) by 26% compared with the culprit lesion-only strategy (hazard ratio 0.74, 95% CI: 0.60-0.91; p=0.004). In COMPLETE, as in several other trials2,3, an angiography-guided strategy was ...