COMPLETE revascularisation improves angina-related QoL

A prespecified analysis of the COMPLETE trial showed that percutaneous coronary intervention (PCI) improved angina-related quality of life (QoL) in patients with ST-elevation myocardial infarction (STEMI) and coronary artery disease (CAD), with more improvement noted in patients receiving complete revascularisation over culprit lesion-only revascularisation. Patients with complete revascularisation were more likely to be angina-free at 3 years than those in the culprit-lesion group.

The previously published COMPLETE trial showed that complete revascularisation (n=2,016) was superior to culprit-only revascularisation (n=2,025) at reducing death or myocardial infarction over 3 years of follow-up [1]. Prof. Shamir Mehta (McMaster University, Canada) presented a prespecified analysis that focused on health-related QoL outcomes measured with the 19-item Seattle Angina Questionnaire (SAQ) at baseline, 6 months, and 3 years [2].

The primary outcome results of SAQ-reported angina frequency showed that from baseline to 3 years, QoL was higher in the complete revascularisation group with 9.8 compared with 9.6 in the culprit-only group (P=0.003). Other subscale measures of the SAQ, including treatment satisfaction, QoL score, and summary score, also favoured complete revascularisation. By 3 years of follow-up, all subscale measures of the SAQ, including physical limitation, favoured complete versus culprit revascularisation. With regard to the presence of residual angina at 3 years, 12.5% in the complete revascularisation group reported it compared with 15.7% in the culprit-only group (P=0.013), with a number-needed-to-treat (NNT) measure of 31 to prevent 1 patient from experiencing angina.

Prof. Mehta noted that the main COMPLETE trial was designed to show a reduction in major cardiovascular events, and most of the benefit of complete revascularisation on cardiovascular death was in those with tighter non-culprit lesion stenosis ≥80%. “Here, for the patient-reported angina analysis, it appears that the benefit on angina specifically is really in the patients with more severe non-culprit lesions,” he added.

1. 
   
   1. Mehta SR, et al. N Engl J Med 2019;381:1411–1421.
   2. Mehta SR, et al. Effects Of Complete Revascularization On Angina-related Quality Of Life In Patients With St-segment Elevation Myocardial Infarction. Abstract 403–12, ACC 2022, 2–4 April, Washington DC, USA.

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Posted on 15 June 202213 June 2024