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Complete versus lesion-only primary PCI: The randomized cardiovascular MR CvLPRIT substudy

Complete versus lesion-only primary PCI: The randomized cardiovascular MR CvLPRIT substudy
Complete versus lesion-only primary PCI: The randomized cardiovascular MR CvLPRIT substudy

BACKGROUND: Complete revascularization may improve outcomes compared with an infarct-related artery (IRA)-only strategy in patients being treated with primary percutaneous coronary intervention (PPCI) who have multivessel disease presenting with ST-segment elevation myocardial infarction (STEMI). However, there is concern that non-IRA PCI may cause additional non-IRA myocardial infarction (MI).

OBJECTIVES: This study sought to determine whether in-hospital complete revascularization was associated with increased total infarct size compared with an IRA-only strategy.

METHODS: This multicenter prospective, randomized, open-label, blinded endpoint clinical trial evaluated STEMI patients with multivessel disease having PPCI within 12 h of symptom onset. Patients were randomized to either IRA-only PCI or complete in-hospital revascularization. Contrast-enhanced cardiovascular magnetic resonance (CMR) was performed following PPCI (median day 3) and stress CMR at 9 months. The pre-specified primary endpoint was infarct size on pre-discharge CMR. The study had 80% power to detect a 4% difference in infarct size with 100 patients per group.

RESULTS: Of the 296 patients in the main trial, 205 participated in the CMR substudy, and 203 patients (98 complete revascularization and 105 IRA-only) completed the pre-discharge CMR. The groups were well-matched. Total infarct size (median, interquartile range) was similar to IRA-only revascularization: 13.5% (6.2% to 21.9%) versus complete revascularization, 12.6% (7.2% to 22.6%) of left ventricular mass, p = 0.57 (95% confidence interval for difference in geometric means 0.82 to 1.41). The complete revascularization group had an increase in non-IRA MI on the pre-discharge CMR (22 of 98 vs. 11 of 105, p = 0.02). There was no difference in total infarct size or ischemic burden between treatment groups at follow-up CMR.

CONCLUSIONS: Multivessel PCI in the setting of STEMI leads to a small increase in CMR-detected non-IRA MI, but total infarct size was not significantly different from an IRA-only revascularization strategy. (Complete Versus Lesion-Only Primary PCI Pilot Study [CvLPRIT]; ISRCTN70913605).

Coronary Angiography, Electrocardiography, Female, Humans, Magnetic Resonance Imaging, Cine/methods, Male, Middle Aged, Myocardial Infarction/diagnosis, Myocardium/pathology, Percutaneous Coronary Intervention/methods, Pilot Projects, Prospective Studies, Treatment Outcome
0735-1097
2713-2724
McCann, Gerry P.
8e61a5f4-0764-4adf-bc9c-5abba82425fc
Khan, Jamal N.
6a97c4cf-a472-4fef-94e6-2bbd66eb44bf
Greenwood, John P.
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Nazir, Sheraz
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Dalby, Miles
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Curzen, Nick
70f3ea49-51b1-418f-8e56-8210aef1abf4
Hetherington, Simon
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Kelly, Damian J.
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Blackman, Daniel J.
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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
3704efef-33b4-430d-a819-60d1bba99706
Gershlick, Anthony H.
5beb7f92-68f7-41df-ba72-ef3d2cdf20b9
McCann, Gerry P.
8e61a5f4-0764-4adf-bc9c-5abba82425fc
Khan, Jamal N.
6a97c4cf-a472-4fef-94e6-2bbd66eb44bf
Greenwood, John P.
af864161-94e9-4094-9c1f-85d696682fb7
Nazir, Sheraz
e1f416ed-9bba-41ab-aa45-564cfe1416b8
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 J.
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.
5beb7f92-68f7-41df-ba72-ef3d2cdf20b9

McCann, Gerry P., Khan, Jamal N., Greenwood, John P., Nazir, Sheraz, Dalby, Miles, Curzen, Nick, Hetherington, Simon, Kelly, Damian J., Blackman, Daniel J., Ring, Arne, Peebles, Charles, Wong, Joyce, Sasikaran, Thiagarajah, Flather, Marcus, Swanton, Howard and Gershlick, Anthony H. (2015) Complete versus lesion-only primary PCI: The randomized cardiovascular MR CvLPRIT substudy. Journal of the American College of Cardiology, 66 (24), 2713-2724. (doi:10.1016/j.jacc.2015.09.099).

Record type: Article

Abstract

BACKGROUND: Complete revascularization may improve outcomes compared with an infarct-related artery (IRA)-only strategy in patients being treated with primary percutaneous coronary intervention (PPCI) who have multivessel disease presenting with ST-segment elevation myocardial infarction (STEMI). However, there is concern that non-IRA PCI may cause additional non-IRA myocardial infarction (MI).

OBJECTIVES: This study sought to determine whether in-hospital complete revascularization was associated with increased total infarct size compared with an IRA-only strategy.

METHODS: This multicenter prospective, randomized, open-label, blinded endpoint clinical trial evaluated STEMI patients with multivessel disease having PPCI within 12 h of symptom onset. Patients were randomized to either IRA-only PCI or complete in-hospital revascularization. Contrast-enhanced cardiovascular magnetic resonance (CMR) was performed following PPCI (median day 3) and stress CMR at 9 months. The pre-specified primary endpoint was infarct size on pre-discharge CMR. The study had 80% power to detect a 4% difference in infarct size with 100 patients per group.

RESULTS: Of the 296 patients in the main trial, 205 participated in the CMR substudy, and 203 patients (98 complete revascularization and 105 IRA-only) completed the pre-discharge CMR. The groups were well-matched. Total infarct size (median, interquartile range) was similar to IRA-only revascularization: 13.5% (6.2% to 21.9%) versus complete revascularization, 12.6% (7.2% to 22.6%) of left ventricular mass, p = 0.57 (95% confidence interval for difference in geometric means 0.82 to 1.41). The complete revascularization group had an increase in non-IRA MI on the pre-discharge CMR (22 of 98 vs. 11 of 105, p = 0.02). There was no difference in total infarct size or ischemic burden between treatment groups at follow-up CMR.

CONCLUSIONS: Multivessel PCI in the setting of STEMI leads to a small increase in CMR-detected non-IRA MI, but total infarct size was not significantly different from an IRA-only revascularization strategy. (Complete Versus Lesion-Only Primary PCI Pilot Study [CvLPRIT]; ISRCTN70913605).

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Accepted/In Press date: 22 September 2015
e-pub ahead of print date: 14 December 2015
Published date: 22 December 2015
Keywords: Coronary Angiography, Electrocardiography, Female, Humans, Magnetic Resonance Imaging, Cine/methods, Male, Middle Aged, Myocardial Infarction/diagnosis, Myocardium/pathology, Percutaneous Coronary Intervention/methods, Pilot Projects, Prospective Studies, Treatment Outcome

Identifiers

Local EPrints ID: 435977
URI: http://eprints.soton.ac.uk/id/eprint/435977
ISSN: 0735-1097
PURE UUID: 691844ec-80c7-4ef9-ac06-37e025554660
ORCID for Nick Curzen: ORCID iD orcid.org/0000-0001-9651-7829

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Date deposited: 25 Nov 2019 17:30
Last modified: 28 Apr 2022 01:55

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Contributors

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

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