Long-Term Follow-Up of Complete Versus Lesion-Only Revascularization in STEMI and Multivessel Disease: The CvLPRIT Trial

Gershlick, Anthony H., Banning, Amerjeet S., Parker, Emma, Wang, Duolao ORCID: https://orcid.org/0000-0003-2788-2464, Budgeon, Charley A., Kelly, Damian J., Kane, Peter O., Dalby, Miles, Hetherington, Simon L., McCann, Gerry P., Greenwood, John P. and Curzen, Nick (2019) 'Long-Term Follow-Up of Complete Versus Lesion-Only Revascularization in STEMI and Multivessel Disease: The CvLPRIT Trial'. Journal of the American College of Cardiology, Vol 74, Issue 25, pp. 3083-3094.

Text Long-Term Follow-Up of Complete Versus Lesion-Only Revascularization in STEMI and Multivessel Disease.docx - Accepted Version Download (2MB)

Abstract

BACKGROUND:
Randomized trials have shown that complete revascularization in patients with ST-segment elevation myocardial infarction (MI) with multivessel disease results in lower major adverse cardiovascular events (MACE) (all-cause death, MI, ischemia-driven revascularization, heart failure).
OBJECTIVES:
The goal of this study was to determine whether the benefits of complete revascularization are sustained long-term and their impact on hard endpoints.
METHODS:
CvLPRIT (Complete versus Lesion-only Primary PCI Trial) was a randomized trial of complete inpatient revascularization versus infarct-related artery revascularization only at the index admission. Randomized patients have been followed longer-term. The components of the original primary endpoint were collected from physical and electronic patient records, and from local databases for all readmissions.
RESULTS:
The median follow-up (achieved in >90% patients) from randomization to first event or last follow-up was 5.6 years (0.0 to 7.3 years). The primary MACE endpoint rate at this time point was 24.0% in the complete revascularization group but 37.7% of the infarct-related artery-only group (hazard ratio: 0.57; 95% confidence interval: 0.37 to 0.87; p = 0.0079). The composite endpoint of all-cause death/MI was 10.0% in the complete revascularization group versus 18.5% in the infarct-related artery-only group (hazard ratio: 0.47; 95% confidence interval: 0.25 to 0.89; p = 0.0175). In a landmark analysis (from 12 months to final follow-up), there was no significant difference between MACE, death/MI, and individual components of the primary endpoint.
CONCLUSIONS:
Long-term follow-up of the CvLPRIT trial shows that the significantly lower rate of MACE in the complete revascularization group, previously seen at 12 months, is sustained to a median of 5.6 years. A significant difference in composite all-cause death/MI favoring the complete revascularization was also observed. (Complete versus Lesion-only Primary PCI Trial; ISRCTN70913605).

Item Type:	Article
Subjects:	WG Cardiovascular System > WG 100 General works 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.2019.10.033
Depositing User:	Marie Hatton
Date Deposited:	24 Jan 2020 13:57
Last Modified:	24 Dec 2020 02:02
URI:	https://archive.lstmed.ac.uk/id/eprint/13593

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