Cardiology Xagena

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Preventative artery repair provides major benefit after serious myocardial infarction

A study has shown that opening all clogged arteries with stents after a serious myocardial infarction is much better than opening only the single clogged artery that caused the infarction.

About half of all myocardial infarction victims are found to have additional clogged arteries in addition to the one that caused their heart attack.
Previously, physicians focused on opening the one artery responsible for myocardial infarction, leaving the other blockages for treatment with medication alone.
The new study, a collaboration of 130 hospitals in 31 countries, has shown that opening all the blockages is better than treating only the one blockage causing myocardial infarction.
This led to a 26% reduction in the patient's risk of dying or having a recurrent heart attack.

The study, known as COMPLETE trial, was published in the New England Journal of Medicine ( NEJM ) and presented at the European Society of Cardiology ( ESC ) Congress together with the World Congress of Cardiology in Paris, France.

Although it had been known that opening of the single blocked artery that caused the myocardial infarction with stents was beneficial, it was unclear whether additional stents to clear the other clogged arteries further prevented death or myocardial infarction.

The COMPLETE study involved 4,041 patients and is the first large, randomized, international trial to show a reduction in major outcomes with this approach.

The benefits emerged over the long term and were similar when the additional stent procedures were done anytime in the first 45 days after myocardial infarction.

Over the median of three years, a second myocardial infarction or cardiovascular death dropped to 7.8% of the patients who had the complete revascularization compared to 10.5% of those who had a stent only for the artery that caused the first myocardial infarction, a highly significant difference.
The benefit was even more sizable when factoring in other untoward events such as severe chest pain necessitating a repeat stenting procedure.
There was no difference between the groups on whether they experienced side effects, including stroke and major bleeding. ( Xagena )

Source: McMaster University, 2019