Complete versus Lesion-only PRimary PCI Trial

Description:

Management of multivessel coronary disease during primary percutaneous coronary intervention (PCI) remains controversial. Current guidelines recommend treating the infarct-related artery. The goal of the CvLPRIT trial was to evaluate PCI of the infarct-related artery compared with complete revascularization at the index admission among participants with ST-segment elevation myocardial infarction (STEMI).

Hypothesis:

Complete revascularization will reduce adverse cardiovascular events.

Drugs/Procedures Used:

Participants with STEMI were randomized to complete revascularization (n = 150) versus culprit vessel-only PCI (n = 146).

Principal Findings:

Overall, 296 patients were randomized. Complete revascularization was performed at the same time as the primary PCI procedure in 59%, and in a staged fashion (median 1.5 days) in 27%.

The primary outcome of mortality, MI, heart failure, and ischemia-driven revascularization at 12 months occurred in 10.0% of the complete revascularization group vs. 21.2% of the culprit-only group (p = 0.009).

- All-cause mortality: 1.3% vs. 4.1% (p = 0.14), respectively

- MI: 1.3% vs. 2.7% (p = 0.39), respectively

- Heart failure: 2.7% vs. 6.2% (p = 0.14), respectively

- Repeat revascularization: 4.7% vs. 8.2% (p = 0.2), respectively

- Major bleeding: 2.2% vs. 4.3% (p = 0.31), respectively

Interpretation:

Among patients with STEMI, complete revascularization appears beneficial at reducing major adverse cardiac events. The duration of the procedure and impact on renal function was not described in the current study. This strategy will need to be re-evaluated in future STEMI guidelines.

Source: www.cardiosource.org