a critic about the complete trial discussing complete revascularization after primary PCI

1. COMPLETE trial critic
Haytham Soliman, MD, FSCAI
Fayoum university

3. 1- Patient risk profile
20%
2%
7%
3%

4. 10% > II

6. • So the study population were a low risk population with low DM, CKD
and stroke percentage
• This do not reflect the majority of population presented with multi
vessel disease

7. Evaluation of the non culprit lesion sevirity

8. •Visual estimation is not accurate in lesions below 90%
specially in the setting of primary PCI!
•FFR also is not accurate in the setting of primary PCI!

9. Lesion type left for medical treatment

10. • They left 3 patients with significant left main disease to medical
treatment!
• And they did PCI to 55 patients having CTO (100%) occlusion and
patients with SCAD and less than 90% regardless the symptoms or
evidence of ischemia

11. Why SCAD or now CCS ?
• All these patients did not perform the non culprit
lesions during primary PCI
• Symptoms did not derive the decision nor the timing
of PCI denoting patient stability
• Some of these patients had PCI after 45 days!
• The average was between three days and three
weeks!

14. The non culprit PCI had no
specific timing
• There was no solid specification about when to do PCI to
non culprit lesion

15. Outcomes

16. primary and secondary co outcomes were statistically
significant for complete revascularization but

18. • There was no mortality benefit at all
• The benefit was driven mainly from MI and ischemia driven
revascularization which is logic
• 98% of patients had lesions above 70%
• there was a trend increase in acute injury caused by contrast
specially in PCI patient during the index hospitalization

19. Not an accurate conclusion

20. This conclusion gave the impression that
there is a mortality benefit from
complete revascularization which is not
true

21. Summary
• Complete trial is studying the concept of doing significant coronary
lesions Vs medical treatment after primary PCI
• It did not specify the timing to PCI to non-culprit lesions
• The evaluation of significant lesion was not based on symptoms or
evidence of ischemia
• It did not show any mortality benefit

22. Thank
you