Table 1: Overview of RCTs Comparing Culprit Only to Multivessel Revascularisation in Acute STEMI Patients.
| RCT | Inclusion period | Culprit only (n) | Complete, index (n) | Complete, staged (n) | Lesion criteria ( % stenosis) | Type of complete revascularisation | Primary endpoint | FUP, months (mean) | Outcome |
|---|---|---|---|---|---|---|---|---|---|
| Politi et al. | 2003–2007 | 84 | 65 | 65 | ≥70 % stenosis in ≥2 N-IRAs | Index complete, or staged after 2 months | MACE | 30 | 63 % relative risk reduction of MACE after immediate complete revascularisation, 60 % after staged revascularisation |
| PRAMI | 2008–2013 | 231 | 234 | na | ≥50 % | Immediate or no preventive PCI | Composite: death from cardiac cause, MI, refractory angina | 23 | 65 % relative risk reduction in primary endpoint due to complete revascularisation, no significant difference in death |
| DANAMI-3 PRIMULTI | 2011–2014 | 313 | na | 314 | ≥50 % in at least 1 N-IRA | Staged FFR guided before discharge | Composite: all-cause death, MI, ischemia-driven revascularisation | 27 | 44 % relative risk reduction in primary endpoint due to reduction in ischaemia-driven revascularisation in complete revascularisation |
| CvULPRIT | 2011–2013 | 146 | 97 | 42 | ≥50 % in 2 vessels, ≥70 % in 1 vessel | Immediate (recommended) or during index admission | MACE (all-cause mortality, MI, heart failure, ischemia-driven revascularisation | 12 | 55 % relative risk reduction in primary endpoint in the complete revascularisation group |
| COMPARE ACUTE | 2011–2015 | 590 | 295 | na | ≥50 % + FFR ≤0.80 | Immediate FFR guided | Composite: all-cause mortality, MI, any revascularisation, cerebrovascular events | 36 | 65 % relative risk reduction of primary endpoint in complete revascularisation (revascularisation driven) |
RCT = randomized controlled trial; FUP = follow up; N-IRA = non-infarct related artery; MACE = major adverse cardiovascular event; PCI = percutaneous coronary intervention; MI = myocardial infarction; FFR = fractional flow reserve.