Author:
Karthikeyan Ganesan,Peix Amalia,Devasenapathy Niveditha,Jimenez-Heffernan Amelia,Haque Saif-ul,Rodella Carlo,Giubbini Raffaele,Rosas Erick Alexanderson,Ozkan Elgin,Keng Yung Jih Felix,Vitola João,Sobic-Saranovic Dragana,Soni Manoj,López Leonardo,Cabrera Lázaro O.,Camacho-Freire Santiago,Manovel-Sanchez Ana,Naeem Hesham,Fatima Shazia,Rinaldi Roberto,Carvajal-Juarez Isabel,Esenboga Kerim,Dondi Maurizio,Paez Diana
Abstract
Abstract
Background
In patients with multi-vessel disease presenting with ST elevation myocardial infarction (STEMI), the efficacy and safety of ischemia-guided, vs routine non-culprit vessel angioplasty has not been adequately studied.
Methods
We conducted an international, randomized, non-inferiority trial comparing ischemia-guided non-culprit vessel angioplasty to routine non-culprit vessel angioplasty, following primary PCI for STEMI. The primary outcome was the between-group difference in percent ischemic myocardium at follow-up stress MPI. All MPI images were processed and analyzed at a central core lab, blinded to treatment allocation.
Results
In all, 109 patients were enrolled from nine countries. In the ischemia-guided arm, 25/48 (47%) patients underwent non-culprit vessel PCI following stress MPI. In the routine non-culprit PCI arm, 43/56 (77%) patients underwent angioplasty (86% within 6 weeks of randomization). The median percentage of ischemic myocardium on follow-up imaging (mean 16.5 months) was low, and identical (2.9%) in both arms (difference 0.13%, 95%CI − 1.3%–1.6%, P < .0001; non-inferiority margin 5%).
Conclusion
A strategy of ischemia-guided non-culprit PCI resulted in low ischemia burden, and was non-inferior to a strategy of routine non-culprit vessel PCI in reducing ischemia burden. Selective non-culprit PCI following STEMI offers the potential for cost-savings, and may be particularly relevant to low-resource settings.
(CTRI/2018/08/015384).
Publisher
Springer Science and Business Media LLC
Subject
Cardiology and Cardiovascular Medicine,Radiology, Nuclear Medicine and imaging
Cited by
4 articles.
订阅此论文施引文献
订阅此论文施引文献,注册后可以免费订阅5篇论文的施引文献,订阅后可以查看论文全部施引文献