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Infarct size following complete revascularization in patients presenting with STEMI: a comparison of immediate and staged in-hospital non-infarct related artery PCI subgroups in the CvLPRIT study

Infarct size following complete revascularization in patients presenting with STEMI: a comparison of immediate and staged in-hospital non-infarct related artery PCI subgroups in the CvLPRIT study
Infarct size following complete revascularization in patients presenting with STEMI: a comparison of immediate and staged in-hospital non-infarct related artery PCI subgroups in the CvLPRIT study

BACKGROUND: The CvLPRIT study showed a trend for improved clinical outcomes in the complete revascularisation (CR) group in those treated with an immediate, as opposed to staged in-hospital approach in patients with multivessel coronary disease undergoing primary percutaneous intervention (PPCI). We aimed to assess infarct size and left ventricular function in patients undergoing immediate compared with staged CR for multivessel disease at PPCI.

METHODS: The Cardiovascular Magnetic Resonance (CMR) substudy of CvLPRIT was a multicentre, prospective, randomized, open label, blinded endpoint trial in PPCI patients with multivessel disease. These data refer to a post-hoc analysis in 93 patients randomized to the CR arm (63 immediate, 30 staged) who completed a pre-discharge CMR scan (median 2 and 4 days respectively) after PPCI. The decision to stage non-IRA revascularization was at the discretion of the treating interventional cardiologist.

RESULTS: Patients treated with a staged approach had more visible thrombus (26/30 vs. 31/62, p = 0.001), higher SYNTAX score in the IRA (9.5, 8-16 vs. 8.0, 5.5-11, p = 0.04) and a greater incidence of no-reflow (23.3 % vs. 1.6 % p < 0.001) than those treated with immediate CR. After adjustment for confounders, staged patients had larger infarct size (19.7 % [11.7-37.6] vs. 11.6 % [6.8-18.2] of LV Mass, p = 0.012) and lower ejection fraction (42.2 ± 10 % vs. 47.4 ± 9 %, p = 0.019) compared with immediate CR.

CONCLUSIONS: Of patients randomized to CR in the CMR substudy of CvLPRIT, those in whom the operator chose to stage revascularization had larger infarct size and lower ejection fraction, which persisted after adjusting for important covariates than those who underwent immediate CR. Prospective randomized trials are needed to assess whether immediate CR results in better clinical outcomes than staged CR.

TRIAL REGISTRATION: ISRCTN70913605 , Registered 24th February 2011.

Aged, Coronary Angiography, Coronary Artery Disease/diagnostic imaging, Female, Humans, Magnetic Resonance Imaging, Male, Middle Aged, Myocardium/pathology, Patient Selection, Percutaneous Coronary Intervention/adverse effects, Predictive Value of Tests, Prospective Studies, Risk Factors, ST Elevation Myocardial Infarction/diagnostic imaging, Stroke Volume, Time Factors, Treatment Outcome, Ventricular Function, Left
1097-6647
Khan, Jamal N.
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Nazir, Sheraz A.
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Greenwood, John P.
af864161-94e9-4094-9c1f-85d696682fb7
Dalby, Miles
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Curzen, Nick
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Hetherington, Simon
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Kelly, Damian J.
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Blackman, Daniel
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Ring, Arne
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Peebles, Charles
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Wong, Joyce
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Sasikaran, Thiagarajah
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Flather, Marcus
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Swanton, Howard
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Gershlick, Anthony H.
5beb7f92-68f7-41df-ba72-ef3d2cdf20b9
McCann, Gerry P.
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Khan, Jamal N.
6a97c4cf-a472-4fef-94e6-2bbd66eb44bf
Nazir, Sheraz A.
e1f416ed-9bba-41ab-aa45-564cfe1416b8
Greenwood, John P.
af864161-94e9-4094-9c1f-85d696682fb7
Dalby, Miles
0296ef2f-0e85-41da-974c-2e709b9494c6
Curzen, Nick
70f3ea49-51b1-418f-8e56-8210aef1abf4
Hetherington, Simon
491bfdf8-38b8-4573-9ea8-aeb59f162f31
Kelly, Damian J.
2dc363f6-884a-4f82-a4d7-bfadf72f9533
Blackman, Daniel
1c03cb3f-3b7e-4f4c-94ed-9b438c4e6243
Ring, Arne
5da69282-2ac3-4873-8cdc-08d807f747fb
Peebles, Charles
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Wong, Joyce
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Sasikaran, Thiagarajah
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Flather, Marcus
f1c158fe-9da3-4604-adfc-a5f8db10d5d3
Swanton, Howard
3704efef-33b4-430d-a819-60d1bba99706
Gershlick, Anthony H.
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McCann, Gerry P.
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Khan, Jamal N., Nazir, Sheraz A., Greenwood, John P., Dalby, Miles, Curzen, Nick, Hetherington, Simon, Kelly, Damian J., Blackman, Daniel, Ring, Arne, Peebles, Charles, Wong, Joyce, Sasikaran, Thiagarajah, Flather, Marcus, Swanton, Howard, Gershlick, Anthony H. and McCann, Gerry P. (2016) Infarct size following complete revascularization in patients presenting with STEMI: a comparison of immediate and staged in-hospital non-infarct related artery PCI subgroups in the CvLPRIT study. Journal of Cardiovascular Magnetic Resonance, 18 (1), [85]. (doi:10.1186/s12968-016-0298-2).

Record type: Article

Abstract

BACKGROUND: The CvLPRIT study showed a trend for improved clinical outcomes in the complete revascularisation (CR) group in those treated with an immediate, as opposed to staged in-hospital approach in patients with multivessel coronary disease undergoing primary percutaneous intervention (PPCI). We aimed to assess infarct size and left ventricular function in patients undergoing immediate compared with staged CR for multivessel disease at PPCI.

METHODS: The Cardiovascular Magnetic Resonance (CMR) substudy of CvLPRIT was a multicentre, prospective, randomized, open label, blinded endpoint trial in PPCI patients with multivessel disease. These data refer to a post-hoc analysis in 93 patients randomized to the CR arm (63 immediate, 30 staged) who completed a pre-discharge CMR scan (median 2 and 4 days respectively) after PPCI. The decision to stage non-IRA revascularization was at the discretion of the treating interventional cardiologist.

RESULTS: Patients treated with a staged approach had more visible thrombus (26/30 vs. 31/62, p = 0.001), higher SYNTAX score in the IRA (9.5, 8-16 vs. 8.0, 5.5-11, p = 0.04) and a greater incidence of no-reflow (23.3 % vs. 1.6 % p < 0.001) than those treated with immediate CR. After adjustment for confounders, staged patients had larger infarct size (19.7 % [11.7-37.6] vs. 11.6 % [6.8-18.2] of LV Mass, p = 0.012) and lower ejection fraction (42.2 ± 10 % vs. 47.4 ± 9 %, p = 0.019) compared with immediate CR.

CONCLUSIONS: Of patients randomized to CR in the CMR substudy of CvLPRIT, those in whom the operator chose to stage revascularization had larger infarct size and lower ejection fraction, which persisted after adjusting for important covariates than those who underwent immediate CR. Prospective randomized trials are needed to assess whether immediate CR results in better clinical outcomes than staged CR.

TRIAL REGISTRATION: ISRCTN70913605 , Registered 24th February 2011.

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Accepted/In Press date: 26 October 2016
Published date: 9 November 2016
Keywords: Aged, Coronary Angiography, Coronary Artery Disease/diagnostic imaging, Female, Humans, Magnetic Resonance Imaging, Male, Middle Aged, Myocardium/pathology, Patient Selection, Percutaneous Coronary Intervention/adverse effects, Predictive Value of Tests, Prospective Studies, Risk Factors, ST Elevation Myocardial Infarction/diagnostic imaging, Stroke Volume, Time Factors, Treatment Outcome, Ventricular Function, Left

Identifiers

Local EPrints ID: 435515
URI: http://eprints.soton.ac.uk/id/eprint/435515
ISSN: 1097-6647
PURE UUID: 2c89a080-0727-4391-a7b5-8778769fc158
ORCID for Nick Curzen: ORCID iD orcid.org/0000-0001-9651-7829

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Date deposited: 08 Nov 2019 17:30
Last modified: 09 Jan 2022 03:19

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Contributors

Author: Jamal N. Khan
Author: Sheraz A. Nazir
Author: John P. Greenwood
Author: Miles Dalby
Author: Nick Curzen ORCID iD
Author: Simon Hetherington
Author: Damian J. Kelly
Author: Daniel Blackman
Author: Arne Ring
Author: Charles Peebles
Author: Joyce Wong
Author: Thiagarajah Sasikaran
Author: Marcus Flather
Author: Howard Swanton
Author: Anthony H. Gershlick
Author: Gerry P. McCann

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