Bainey, Kevin R. (8064642600)Kevin R. (8064642600)BaineyWood, David A. (57208240062)David A. (57208240062)WoodBossard, Matthias (55670024300)Matthias (55670024300)BossardCampo, Gianluca (8937083300)Gianluca (8937083300)CampoCantor, Warren J. (7003446524)Warren J. (7003446524)CantorLavi, Shahar (57203238237)Shahar (57203238237)LaviMadan, Mina (7102357147)Mina (7102357147)MadanMehran, Roxana (7004992409)Roxana (7004992409)MehranPinilla-Echeverri, Natalia (55315146100)Natalia (55315146100)Pinilla-EcheverriRao, Sunil (57216409009)Sunil (57216409009)RaoSarma, Jaydeep (35724660400)Jaydeep (35724660400)SarmaSheth, Tej (6602892196)Tej (6602892196)ShethStankovic, Goran (59150945500)Goran (59150945500)StankovicSteg, Phillipe Gabriel (57203081180)Phillipe Gabriel (57203081180)StegStorey, Robert F. (7101733693)Robert F. (7101733693)StoreyTanguay, Jean-Francois (7003916903)Jean-Francois (7003916903)TanguayVelianou, James L. (6602617374)James L. (6602617374)VelianouWelsh, Robert C. (35239007400)Robert C. (35239007400)WelshMani, Thenmozhi (56825619800)Thenmozhi (56825619800)ManiCairns, John A. (7201705929)John A. (7201705929)CairnsMehta, Shamir R. (57212016579)Shamir R. (57212016579)Mehta2025-06-122025-06-122024https://doi.org/10.1016/j.ahj.2023.10.004https://www.scopus.com/inward/record.uri?eid=2-s2.0-85178333473&doi=10.1016%2fj.ahj.2023.10.004&partnerID=40&md5=37cfda2450c9931e692f854588d33acahttps://remedy.med.bg.ac.rs/handle/123456789/2006Background: In ST-segment elevation myocardial infarction (STEMI), complete revascularization with percutaneous coronary intervention (PCI) reduces major cardiovascular events compared with culprit-lesion-only PCI. Whether age influences these results remains unknown. Methods: COMPLETE was a multinational, randomized trial evaluating a strategy of staged complete revascularization, consisting of angiography-guided PCI of all suitable nonculprit lesions, versus a strategy of culprit-lesion-only PCI. In this prespecified subgroup analysis, treatment effect according to age (≥65 years vs <65 years) was determined for the first coprimary outcome of cardiovascular (CV) death or new myocardial infarction (MI) and the second coprimary outcome of CV death, new MI, or ischemia-driven revascularization (IDR). Median follow-up was 35.8 months (interquartile range [IQR]: 27.6-44.3 months). Results: Of 4,041 patients randomized in COMPLETE, 1,613 were aged ≥ 65 years (39.9%). Higher event rates were observed for both coprimary outcomes in patients aged ≥ 65 years comparted with those aged < 65 years (11.2% vs 7.9%, HR 1.49, 95% CI 1.22-1.83; 14.4% vs 11.8%, HR 1.28, 95% CI 1.07-1.52, respectively). Complete revascularization reduced the first coprimary outcome in patients ≥ 65 years (9.7% vs 12.5%, HR 0.77; 95% CI, 0.58-1.04) and < 65 years (6.7% vs 9.1%, HR 0.72; 95% CI, 0.54-0.96)(interaction P = .74). The second coprimary outcome was reduced in those ≥ 65 years (HR 0.56, 95% CI, 0.43-0.74) and < 65 years (HR 0.48, 95% CI, 0.37-0.61 (interaction P = .37). A sensitivity analysis was performed with consistent results demonstrated using a 75-year threshold (albeit attenuated). Conclusions: In patients with STEMI and multivessel CAD, complete revascularization compared with culprit-lesion-only PCI reduced major cardiovascular events regardless of patient age and could be considered as a revascularization strategy in older adults. © 2023 Elsevier Inc.