Why is this study important?
This study presented at the recent meeting of the American College of Cardiology is a sub-study of the complete trial which was published in 2019. The full complete trial was a pro SPECT of randomized trial of complete versus culprit only revascularization to treat multivessel disease after early PCI for STEMI. In this trial approximately 2,000 patients were randomized to each arm. There were followed for three years. The overall results confirmed that the strategy of complete revascularization post STEMI reduced the endpoints of death or myocardial infarction (MI) and the combination endpoint of death MI or ischemia directed revascularization.
What question was the study supposed to answer?
This current presentation of the quality-of-life sub study evaluates the quality-of-life differences in the 2 arms at baseline and at 3-year follow-up. Quality of life was assessed by the Seattle Angina Questionnaire (SAQ) at baseline 6 months and 3-year follow-up. The SAQ assesses frequency of angina treatment satisfaction, angina stability, physical limitation, and overall quality of life. This study is important because patients are interested in not only death recurrent infarction and the need for recurrent revascularization procedures, but in their overall daily quality of life. It is especially important for physicians to be able to discuss this issue with patients when choosing interventional strategies.
The question the sub study was designed to answer was did the complete revascularization strategy for early PCI for STEMI improve the patient's overall quality of life and was this improvement durable over a 3-year follow-up.
What did the study show?
The results of the study revealed that the completely vascular strategy improved the SAQ's overall score, quality of life score treatment satisfaction score, physical limitations score and angina frequency score. In addition, both the complete revascularization and the culprit lesion only, strategy resulted in substantial improvement in overall angina related quality of life compared with baseline. At a median of 3-year follow-up a greater proportion of patients were free of angina in the complete revascularization group than in the culprit lesion only group, translating into a number needed to treat of 31 patients to prevent one patient from experiencing angina and a median follow-up of 3 years.
Therefore, this study shows that complete revascularization strategy improves overall patient reported health status as determined by quantitative quality of life assessment, in addition to was established benefit reducing major cardiovascular events. Therefore, physicians can provide this information to patients in the context of shared decision-making as it relates to coronary artery vascularization patients with STEMI.
All editors: Gary S. Ledley, MD, FSCAI
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