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Randomized Trial of Complete Versus Lesion-Only Revascularization in Patients Undergoing Primary Percutaneous Coronary Intervention for STEMI and Multivessel Disease

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Gershlick, Anthony H., Khan, Jamal Nasir, Kelly, Damian J., Greenwood, John P., Sasikaran, Thiagarajah, Curzen, Nick, Blackman, Daniel J., Dalby, Miles, Fairbrother, Kathryn L., Banya, Winston, Wang, Duolao ORCID: https://orcid.org/0000-0003-2788-2464, Flather, Marcus, Hetherington, Simon L., Kelion, Andrew D., Talwar, Suneel, Gunning, Mark, Hall, Roger, Swanton, Howard and McCann, Gerry P. (2015) 'Randomized Trial of Complete Versus Lesion-Only Revascularization in Patients Undergoing Primary Percutaneous Coronary Intervention for STEMI and Multivessel Disease'. Journal of the American College of Cardiology, Vol 65, Issue 10, pp. 963-972.

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Abstract

Background

The optimal management of patients found to have multivessel disease while undergoing primary percutaneous coronary intervention (P-PCI) for ST-segment elevation myocardial infarction is uncertain.

Objectives

CvLPRIT (Complete versus Lesion-only Primary PCI trial) is a U.K. open-label randomized study comparing complete revascularization at index admission with treatment of the infarct-related artery (IRA) only.

Methods

After they provided verbal assent and underwent coronary angiography, 296 patients in 7 U.K. centers were randomized through an interactive voice-response program to either in-hospital complete revascularization (n = 150) or IRA-only revascularization (n = 146). Complete revascularization was performed either at the time of P-PCI or before hospital discharge. Randomization was stratified by infarct location (anterior/nonanterior) and symptom onset (≤3 h or >3 h). The primary endpoint was a composite of all-cause death, recurrent myocardial infarction (MI), heart failure, and ischemia-driven revascularization within 12 months.

Results

Patient groups were well matched for baseline clinical characteristics. The primary endpoint occurred in 10.0% of the complete revascularization group versus 21.2% in the IRA-only revascularization group (hazard ratio: 0.45; 95% confidence interval: 0.24 to 0.84; p = 0.009). A trend toward benefit was seen early after complete revascularization (p = 0.055 at 30 days). Although there was no significant reduction in death or MI, a nonsignificant reduction in all primary endpoint components was seen. There was no reduction in ischemic burden on myocardial perfusion scintigraphy or in the safety endpoints of major bleeding, contrast-induced nephropathy, or stroke between the groups.

Conclusions

In patients presenting for P-PCI with multivessel disease, index admission complete revascularization significantly lowered the rate of the composite primary endpoint at 12 months compared with treating only the IRA. In such patients, inpatient total revascularization may be considered, but larger clinical trials are required to confirm this result and specifically address whether this strategy is associated with improved survival. (Complete Versus Lesion-only Primary PCI Pilot Study [CvLPRIT]; ISRCTN70913605)

Item Type: Article
Subjects: WG Cardiovascular System > WG 120 Cardiovascular diseases
WG Cardiovascular System > WG 20 Research (General)
WG Cardiovascular System > Heart. Heart Diseases > WG 200 General works
Faculty: Department: Clinical Sciences & International Health > Clinical Sciences Department
Digital Object Identifer (DOI): https://doi.org/10.1016/j.jacc.2014.12.038
Depositing User: Lynn Roberts-Maloney
Date Deposited: 06 Nov 2015 10:03
Last Modified: 06 Sep 2019 15:26
URI: https://archive.lstmed.ac.uk/id/eprint/5377

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