Randomized Trial of Complete vs. Culprit-Only PCI in STEMI

Summary and Comment |
March 30, 2015

Randomized Trial of Complete vs. Culprit-Only PCI in STEMI

  1. Howard C. Herrmann, MD

Complete revascularization during index hospitalization improved outcomes.

  1. Howard C. Herrmann, MD

For patients with ST-segment elevation myocardial infarction (STEMI) and multivessel disease, both the treatment of non–infarct-related arteries (IRA) and the timing of such treatment, if used, are controversial. In this multicenter, randomized trial, 146 patients in the U.K. presenting with STEMI received IRA-only percutaneous coronary intervention and were compared with 150 patients who underwent complete revascularization (including non-IRA) during either the initial procedure (in about two thirds) or before hospital discharge.

The primary composite endpoint of all-cause mortality, recurrent MI, heart failure, and ischemia-driven revascularization at 12 months was significantly lower with complete revascularization (10.0%) than with IRA-only intervention (21.2%; hazard ratio, 0.45). Each individual endpoint had a similar reduction, including a nonsignificant trend toward lower mortality (1.3% vs. 4.1%). There was a nonsignificant trend toward reduced events after complete revascularization at the initial procedure (6.2%) versus after a staged approach (11.9%).

Comment

This relatively small but randomized study confirms the benefit of early complete revascularization for STEMI patients that was observed in the PRAMI trial (JW Cardiology Oct 2013). Taken together, these data will likely prompt a change in guideline recommendations as well as in practice. Nonetheless, to further refine the complete-revascularization strategy, additional trials are needed with greater power to detect individual endpoints and to address timing and the roles of fractional flow reserve and noninvasive testing to further stratify nonculprit lesions.

Editor Disclosures at Time of Publication

  • Disclosures for Howard C. Herrmann, MD at time of publication Consultant / Advisory board Gerson Lehrman Group; Siemens; St. Jude Medical; Leerink Swann; Wells Fargo; Massachusetts Medical Society; Morgan Stanley; Edwards Lifesciences Speaker's bureau Society of Cardiovascular Angiography and Interventions; Montefiore Medical Center; American Association for Thoracic Surgery Equity Micro-Interventional Devices, Inc. Grant / Research support Abbott Vascular; Edwards Lifesciences; Gore; Medtronic; St. Jude Medical; Siemens; Boston Scientific; Regado Biosciences; Cordis; Cardiokinetix; University of Laval; MitraSpan Editorial boards Catheterization and Cardiovascular Interventions; Circulation-Cardiovascular Interventions; Journal of Interventional Cardiology; Journal of Invasive Cardiology

Citation(s):

Your Comment

(will not be published)

Filtered HTML

  • Allowed HTML tags: <a> <em> <strong> <cite> <blockquote> <code> <ul> <ol> <li> <dl> <dt> <dd>
  • Web page addresses and e-mail addresses turn into links automatically.
  • Lines and paragraphs break automatically.

Plain text

  • No HTML tags allowed.
  • Web page addresses and e-mail addresses turn into links automatically.
  • Lines and paragraphs break automatically.
Do you have any conflict of interest to disclose?
CAPTCHA
This question is for testing whether you are a human visitor and to prevent automated spam submissions.

Vertical Tabs

* Required

Reader comments are intended to encourage lively discussion of clinical topics with your peers in the medical community. We ask that you keep your remarks to a reasonable length, and we reserve the right to withhold publication of remarks that do not meet this standard.

PRIVACY: We will not use your email address, submitted for a comment, for any other purpose nor sell, rent, or share your e-mail address with any third parties. Please see our Privacy Policy.