Abstract Body (Do not enter title and authors here):
Background:
Randomized trials have demonstrated that complete revascularization reduces non-fatal cardiovascular events in patients with acute myocardial infarction (AMI) and multivessel coronary artery disease (CAD). However, the robustness of this benefit and whether it also reduces cardiovascular (CV) and all-cause death is uncertain.

Objective:
To determine if complete revascularization in patients presenting with AMI and multi-vessel disease reduces the composite of CV death or new MI and CV death alone compared with culprit-lesion only PCI.

Methods:
We performed a collaborative individual patient data meta-analysis of 6 randomized trials involving 8,836 patients comparing complete versus culprit lesion-only PCI in patients with AMI and multivessel CAD. The main outcomes were the composite of CV death or new MI and CV death alone. All cause death was the secondary outcome. Hierarchical testing of CV death alone was planned contingent upon a significant reduction in CV death or new MI, using a pre-specified alpha level. A one-stage IPD meta-analysis was performed using a Cox frailty model.

Results:
The mean age was 66 years and 24% were female. Overall, 88% presented with STEMI and 12% with NSTEMI. In the complete revascularization group, 75% had staged non-culprit lesion PCI and 25% had a single-sitting procedure. At a mean follow-up of 38 months, CV death or new MI occurred in 384 patients (9.0%) in the complete revascularization group compared with 531 (11.6%) in the culprit lesion-only (Hazard Ratio (HR) 0.76; 95% Confidence Interval (CI) 0.67-0.87, P<0.001). There were 156 CV deaths (3.7%) in the complete revascularization group compared with 209 (4.6%) in the culprit lesion-only group (HR 0.76; 95% CI 0.62-0.94, P=0.01). All-cause death occurred in 307 patients (7.2%) in the complete revascularization group compared with 371 (8.1%) in the culprit lesion-only group (HR 0.85 95% CI 0.73-0.99, P=0.03).

Conclusions:
In patients presenting with acute MI and multi-vessel CAD, complete revascularization reduced the composite of CV death or new MI as well as CV death alone. In addition, all-cause death was lower with complete revascularization. This individual patient data meta-analysis provides the strongest and most robust evidence to date that complete revascularization improves important clinical outcomes, further reinforcing current Class 1 guideline recommendations in this population.