How Does Age Impact Complete Revascularization in Patients with STEMI?

The COMPLETE trial demonstrated that a treatment strategy of staged complete revascularization, consisting of angiography-guided percutaneous coronary intervention (PCI, a minimally invasive procedure to open a blocked artery) of all suitable nonculprit lesions, reduced the number of major cardiovascular (CV) events when compared to culprit-lesion-only PCI in STEMI patients with multivessel disease. In this subgroup analysis of the COMPLETE study (COMPELETE-AGE), CVC faculty members, Drs. Kevin Bainey and Robert Welsh, with their fellow researchers, sought to examine if and how these results are impacted by patient age. 

Out of the total 4,041 patients enrolled in COMPLETE, 2,016 were randomized to complete revascularization and 2,025 to culprit-lesion-only PCI. Of these patients, 1,613 were 65 years of age or older. The researchers examined treatment effect based on age (≥65 years vs. <65 years) and the coprimary outcomes of: [1] CV death or new myocardial infarction (MI), and [2] CV death, new MI, or ischemia driven revascularization (performed because the patient is experiencing ischemic symptoms, i.e., chest pain, elevated heart rate, etc.). 

The researchers observed higher event rates of both coprimary outcomes in patients ≥65 years compared to patients <65 years; however, regardless of patient age, complete revascularization compared with culprit-lesion-only PCI was shown to reduce major CV events. For this reason, the study authors recommend that staged multivessel PCI be considered as a revascularization strategy in older STEMI patients.

“This provides us with tremendous reassurance in performing complete revascularization in all patients regardless of age,” says lead author Dr. Kevin Bainey. “The elderly patients appear to derive particular benefits.”