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J Am Coll Cardiol. 2015 Mar 17;65(10):963-72. doi: 10.1016/j.jacc.2014.12.038.

Randomized trial of complete versus lesion-only revascularization in patients undergoing primary percutaneous coronary intervention for STEMI and multivessel disease: the CvLPRIT trial.

Author information

1
Department of Cardiovascular Sciences, University of Leicester and National Institute of Health Research Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital, Leicester, United Kingdom. Electronic address: agershlick@aol.com.
2
Department of Cardiovascular Sciences, University of Leicester and National Institute of Health Research Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital, Leicester, United Kingdom.
3
Department of Cardiology, Royal Derby Hospital, Derby, United Kingdom.
4
Multidisciplinary Cardiovascular Research Centre and the Division of Cardiovascular and Diabetes Research, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom; Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom.
5
Clinical Trials and Evaluation Unit, Royal Brompton & Harefield NHS Foundation Trust and Imperial College London, London, United Kingdom.
6
University Hospital Southampton and Faculty of Medicine, University of Southampton, Southampton, United Kingdom.
7
Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom.
8
Royal Brompton & Harefield NHS Trust, London, United Kingdom.
9
University Hospitals of Leicester NHS Trust, Leicester, United Kingdom.
10
National Institute for Health Research Cardiovascular Biomedical Research Unit, Royal Brompton & Harefield NHS Trust, London, United Kingdom.
11
Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom.
12
Norfolk and Norwich University Hospitals NHS Foundation Trust and Norwich Medical School, University of East Anglia Norwich, United Kingdom.
13
Kettering General Hospital, Kettering, United Kingdom.
14
Oxford Heart Centre, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford, United Kingdom.
15
Royal Bournemouth Hospital, Bournemouth, United Kingdom.
16
Royal Stoke University Hospital, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, Staffordshire, United Kingdom.
17
The Heart Hospital, University College London Hospitals, London, United Kingdom.

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.

KEYWORDS:

complete revascularization; non-infarct-related lesion; primary percutaneous coronary angioplasty

PMID:
25766941
PMCID:
PMC4359051
DOI:
10.1016/j.jacc.2014.12.038
[Indexed for MEDLINE]
Free PMC Article

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