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Complete Versus culprit-Lesion only PRimary PCI Trial (CVLPRIT): a multicentre trial testing management strategies when multivessel disease is detected at the time of primary PCI: rationale and design

Complete Versus culprit-Lesion only PRimary PCI Trial (CVLPRIT): a multicentre trial testing management strategies when multivessel disease is detected at the time of primary PCI: rationale and design
Complete Versus culprit-Lesion only PRimary PCI Trial (CVLPRIT): a multicentre trial testing management strategies when multivessel disease is detected at the time of primary PCI: rationale and design
Aims: Primary percutaneous coronary intervention (PPCI) is the preferred strategy for acute ST-segment elevation myocardial infarction (STEMI), with evidence of improved clinical outcomes compared to fibrinolytic therapy. However, there is no consensus on how best to manage multivessel coronary disease detected at the time of PPCI, with little robust data on best management of angiographically significant stenoses detected in non-infarct-related (N-IRA) coronary arteries. CVLPRIT will determine the optimal management of N-IRA lesions detected during PPCI.

Methods and results: CVLPRIT (Complete Versus culprit-Lesion only PRimary PCI Trial) is an open-label, prospective, randomised, multicentre trial. STEMI patients undergo verbal “assent” on presentation. Patients are included when angiographic MVD has been detected, and randomised to culprit (IRA)-only PCI (n=150) or in-patient complete multivessel PCI (n=150). Cumulative major adverse cardiac events (MACE) - all-cause mortality, recurrent MI, heart failure, need for revascularisation (PCI or CABG) will be recorded at 12 months. Secondary endpoints include safety endpoints of confirmed ischaemic stroke, intracranial haemorrhage, major non-intracranial bleeding, and repair of vascular complications. A cardiac magnetic resonance (CMR) substudy will provide mechanistic data on infarct size, myocardial salvage index and microvascular obstruction. A cost efficacy analysis will be undertaken.

Conclusions: The management of multivessel coronary artery disease in the setting of PPCI for STEMI, including the timing of when to perform non-culprit-artery revascularisation if undertaken, remains unresolved. CVLPRIT will yield mechanistic insights into the myocardial consequence of N-IRA intervention undertaken during the peri-infarct period.

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primary angioplasty, stemi, multivessel coronary artery disease
1774-024X
1190-1198
Kelly, D.J.
07520de6-b224-42b0-91ce-74530777c4e9
McCann, G.P.
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Blackman, D.
354b025f-6255-49ce-a1fb-34c12eb1d83f
Curzen, N.
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Dalby, M.
7938dc0c-acd2-4b86-82dd-413e88dd5078
Greenwood, J.
a40782c8-0b49-4916-98a3-376b88bd05b0
Fairbrother, K.
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Shipley, L.
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Kelion, A.
0c68fce5-c796-4e17-9775-2119e7ad646e
Heatherington, S.
2333e373-52f0-41e5-9758-5acc43daf608
Khan, J.
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Nazir, S.
07452153-23e7-44b3-bed0-891a2f058eb6
Alahmar, A.
c1a1c9fd-0d03-418a-a55b-fe329d36ebce
Flather, M.
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Swanton, H.
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Scholfield, P.
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Gunning, M.
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Hall, R.
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Gershlick, A.
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Kelly, D.J.
07520de6-b224-42b0-91ce-74530777c4e9
McCann, G.P.
7a6a289f-b7ce-4380-926d-26145bc032e8
Blackman, D.
354b025f-6255-49ce-a1fb-34c12eb1d83f
Curzen, N.
70f3ea49-51b1-418f-8e56-8210aef1abf4
Dalby, M.
7938dc0c-acd2-4b86-82dd-413e88dd5078
Greenwood, J.
a40782c8-0b49-4916-98a3-376b88bd05b0
Fairbrother, K.
fe2175a8-830c-4872-bd93-f32d28b42cfd
Shipley, L.
bdc968a3-f3c4-47e3-886c-bc04e338fb86
Kelion, A.
0c68fce5-c796-4e17-9775-2119e7ad646e
Heatherington, S.
2333e373-52f0-41e5-9758-5acc43daf608
Khan, J.
4526d069-505e-4f13-a002-b259c8d04b50
Nazir, S.
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Alahmar, A.
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Flather, M.
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Swanton, H.
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Scholfield, P.
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Gunning, M.
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Hall, R.
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Gershlick, A.
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Kelly, D.J., McCann, G.P. and Blackman, D. et al. (2013) Complete Versus culprit-Lesion only PRimary PCI Trial (CVLPRIT): a multicentre trial testing management strategies when multivessel disease is detected at the time of primary PCI: rationale and design. EuroIntervention, 8 (10), 1190-1198. (doi:10.4244/EIJV8I10A183). (PMID:23425543)

Record type: Article

Abstract

Aims: Primary percutaneous coronary intervention (PPCI) is the preferred strategy for acute ST-segment elevation myocardial infarction (STEMI), with evidence of improved clinical outcomes compared to fibrinolytic therapy. However, there is no consensus on how best to manage multivessel coronary disease detected at the time of PPCI, with little robust data on best management of angiographically significant stenoses detected in non-infarct-related (N-IRA) coronary arteries. CVLPRIT will determine the optimal management of N-IRA lesions detected during PPCI.

Methods and results: CVLPRIT (Complete Versus culprit-Lesion only PRimary PCI Trial) is an open-label, prospective, randomised, multicentre trial. STEMI patients undergo verbal “assent” on presentation. Patients are included when angiographic MVD has been detected, and randomised to culprit (IRA)-only PCI (n=150) or in-patient complete multivessel PCI (n=150). Cumulative major adverse cardiac events (MACE) - all-cause mortality, recurrent MI, heart failure, need for revascularisation (PCI or CABG) will be recorded at 12 months. Secondary endpoints include safety endpoints of confirmed ischaemic stroke, intracranial haemorrhage, major non-intracranial bleeding, and repair of vascular complications. A cardiac magnetic resonance (CMR) substudy will provide mechanistic data on infarct size, myocardial salvage index and microvascular obstruction. A cost efficacy analysis will be undertaken.

Conclusions: The management of multivessel coronary artery disease in the setting of PPCI for STEMI, including the timing of when to perform non-culprit-artery revascularisation if undertaken, remains unresolved. CVLPRIT will yield mechanistic insights into the myocardial consequence of N-IRA intervention undertaken during the peri-infarct period.

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More information

Published date: February 2013
Keywords: primary angioplasty, stemi, multivessel coronary artery disease
Organisations: Human Development & Health

Identifiers

Local EPrints ID: 355249
URI: http://eprints.soton.ac.uk/id/eprint/355249
ISSN: 1774-024X
PURE UUID: 05919213-a2cb-4d3d-8cb0-4b304a089e05
ORCID for N. Curzen: ORCID iD orcid.org/0000-0001-9651-7829

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Date deposited: 19 Aug 2013 12:35
Last modified: 09 Jan 2022 03:19

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Contributors

Author: D.J. Kelly
Author: G.P. McCann
Author: D. Blackman
Author: N. Curzen ORCID iD
Author: M. Dalby
Author: J. Greenwood
Author: K. Fairbrother
Author: L. Shipley
Author: A. Kelion
Author: S. Heatherington
Author: J. Khan
Author: S. Nazir
Author: A. Alahmar
Author: M. Flather
Author: H. Swanton
Author: P. Scholfield
Author: M. Gunning
Author: R. Hall
Author: A. Gershlick

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