title: A Randomized Trial of Complete Versus Culprit-Only Revascularization During Primary Percutaneous Coronary Intervention in Diabetic Patients With Acute ST Elevation Myocardial Infarction and Multi Vessel Disease.
abstract: Recent randomized trials and meta-analyses demonstrated that a complete revascularization of significant non culprit lesions in patients with ST elevation myocardial infarction (STEMI) is superior to a culprit only revascularization approach in reducing major adverse cardiac events (MACE), however the proportion of diabetic patients was low in these trials.
  
  
  
  To investigate whether a complete revascularization approach is associated with better outcomes in diabetic patients with STEMI and multi-vessel disease.
  
  
  
  One hundred diabetic patients with acute STEMI with at least one non-culprit lesion were randomized to either complete revascularization (n = 50) or culprit-only treatment (n = 50). Complete revascularization was performed either at the time of primary percutaneous coronary intervention (PCI) or within 72 hours during hospitalization. The primary endpoint was the composite of all-cause mortality, recurrent MI, and ischemia-driven revascularization at 6 months.
  
  
  
  A complete revascularization approach was significantly associated with a reduction in the primary outcome (6% vs. 24%, P = 0.01), primarily due to reduction in ischemia driven revascularization in the complete revascularization group (2% vs. 12%; P = 0.047). There was no significant reduction in death or MI (2% vs. 8%; P = 0.17) and (2% vs. 4%; P = 0.56) respectively, or in the safety endpoints of major or minor bleeding, contrast-induced nephropathy, or stroke between the groups.
  
  
  
  In diabetic patients with multi-vessel coronary artery disease undergoing PPCI, complete revascularization is associated with significantly reduced risk of adverse cardiovascular events, as compared with culprit vessel only PCI. (J Interven Cardiol 2016;29:241-247).
authors.affiliation: Department of Cardiology, Ain-Shams University, Cairo, Egypt.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Hamza
authors.affiliation: Division of Cardiology, Department of Medicine, University of Florida, Gainesville, Florida.
authors.forename: Ahmed
authors.initials: N
authors.lastname: Mahmoud
authors.affiliation: Department of Medicine, University of Florida, Gainesville, Florida.
authors.forename: Islam Y
authors.initials: IY
authors.lastname: Elgendy
mesh_terms: D000368:Aged; D003920:Diabetes Mellitus / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D011183:Postoperative Complications; D011446:Prospective Studies; D000072657:ST Elevation Myocardial Infarction / Q000150:complications / Q000601:surgery*; D016896:Treatment Outcome