Infarct size following complete revascularization in patients presenting with STEMI: a comparison of immediate and staged in-hospital non-infarct related artery PCI subgroups in the CvLPRIT studyReport as inadecuate




Infarct size following complete revascularization in patients presenting with STEMI: a comparison of immediate and staged in-hospital non-infarct related artery PCI subgroups in the CvLPRIT study - Download this document for free, or read online. Document in PDF available to download.

Journal of Cardiovascular Magnetic Resonance

, 18:85

First Online: 09 November 2016Received: 19 May 2016Accepted: 26 October 2016

Abstract

BackgroundThe CvLPRIT study showed a trend for improved clinical outcomes in the complete revascularisation CR group in those treated with an immediate, as opposed to staged in-hospital approach in patients with multivessel coronary disease undergoing primary percutaneous intervention PPCI. We aimed to assess infarct size and left ventricular function in patients undergoing immediate compared with staged CR for multivessel disease at PPCI.

MethodsThe Cardiovascular Magnetic Resonance CMR substudy of CvLPRIT was a multicentre, prospective, randomized, open label, blinded endpoint trial in PPCI patients with multivessel disease. These data refer to a post-hoc analysis in 93 patients randomized to the CR arm 63 immediate, 30 staged who completed a pre-discharge CMR scan median 2 and 4 days respectively after PPCI. The decision to stage non-IRA revascularization was at the discretion of the treating interventional cardiologist.

ResultsPatients treated with a staged approach had more visible thrombus 26-30 vs. 31-62, p = 0.001, higher SYNTAX score in the IRA 9.5, 8–16 vs. 8.0, 5.5–11, p = 0.04 and a greater incidence of no-reflow 23.3 % vs. 1.6 % p < 0.001 than those treated with immediate CR. After adjustment for confounders, staged patients had larger infarct size 19.7 % 11.7–37.6 vs. 11.6 % 6.8–18.2 of LV Mass, p = 0.012 and lower ejection fraction 42.2 ± 10 % vs. 47.4 ± 9 %, p = 0.019 compared with immediate CR.

ConclusionsOf patients randomized to CR in the CMR substudy of CvLPRIT, those in whom the operator chose to stage revascularization had larger infarct size and lower ejection fraction, which persisted after adjusting for important covariates than those who underwent immediate CR. Prospective randomized trials are needed to assess whether immediate CR results in better clinical outcomes than staged CR.

Trial registrationISRCTN70913605, Registered 24th February 2011.

KeywordsMyocardial infarction Primary percutaneous coronary intervention Multivessel disease Cardiovascular magnetic resonance Infarct size AbbreviationsAARArea-at-risk

CMRCardiovascular magnetic resonance

CRComplete revascularisation

CvLPRITComplete versus Lesion-only Primary PCI Trial

IRAInfarct related artery

LGELate gadolinium enhanced

LVLeft ventricular

MSIMyocardial salvage index

PPCIPrimary percutaneous coronary intervention

STEMIST-Segment elevation myocardial infarction

TIMIThrombolysis in myocardial infarction

Electronic supplementary materialThe online version of this article doi:10.1186-s12968-016-0298-2 contains supplementary material, which is available to authorized users.

Download fulltext PDF



Author: Jamal N. Khan - Sheraz A. Nazir - John P. Greenwood - Miles Dalby - Nick Curzen - Simon Hetherington - Damian J. Kelly

Source: https://link.springer.com/article/10.1186/s12968-016-0298-2



DOWNLOAD PDF




Related documents