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Title: The Randomized Complete vs. Lesion Only Primary PCI Trial - Cardiovascular MRI substudy
Other Titles: CvLPRIT CMR substudy
Authors: McCann, Gerald P.
Khan, J. N.
Greenwood, J. P.
Nazir, S. A.
Dalby, M.
Curzen, N.
Hetherington, S.
Kelly, D. J.
Blackman, D.
Ring, A.
Peebles, C.
Wong, J.
Sasikaran, T.
Flather, M.
Swanton, H.
Gershlick, Anthony H.
First Published: 16-Mar-2015
Publisher: Elsevier for American College of Cardiology
Citation: Journal or the American Journal of Cardiology, 2015, 65(10) Supplement, A17
Abstract: Background: Complete revascularization may improve outcomes compared to an infarct related artery (IRA) only strategy in patients being treated with primary percutaneous coronary intervention (PPCI) who have multivessel disease presenting with ST-segment elevation myocardial infarction (STEMI). However, there is concern that non-IRA PCI may cause additional non-IRA myocardial infarction (MI). Objectives: To determine whether in-hospital complete revascularization was associated with increased total infarct size compared to an IRA-only strategy in the Complete versus Lesion-only Primary PCI Trial Cardiovascular MRI substudy (CvLPRIT-CMR). Methods: Multicentre prospective, randomized, open-label, blinded endpoint clinical trial in STEMI patients with multivessel disease having PPCI within 12 hours of symptom onset. Patients were randomized to either IRA-only PCI or complete in-hospital revascularisation. Contrast-enhanced CMR was performed following PPCI (median day 3) and stress CMR at 9 months. The pre-specified primary endpoint was infarct size on pre-discharge CMR. The study had 80% power to detect a 4% difference in infarct size with 100 patients per group. Results: Of the 296 patients in the main trial, 205 participated in the CMR substudy and 203 patients (98 complete revascularization and 105 IRA-only) completed the acute CMR. The groups were well matched. Total infarct size (median, interquartile range) was similar with IRA-only revascularization: 13.5% (6.2-21.9%) vs. complete revascularization, 12.6% (7.2-22.6) of LV mass, p=0.57 (95% CI for difference in geometric means: 0.82 to 1.41). The complete revascularization group had an increase in non-IRA MI on the acute CMR (22/98 v 11/105, p=0.02). There was no difference in total infarct size or ischemic burden between treatment groups at follow-up CMR. Conclusions: Multivessel PCI in the setting of STEMI leads to a small increase in CMR detected non-IRA MI but total infarct size was not significantly different from an IRA-only revascularization strategy.
DOI Link: 10.1016/S0735-1097(15)60017-1
ISSN: 0735-1097
eISSN: 1558-3597
Version: Post-print
Status: Peer-reviewed
Type: Journal Article
Rights: Copyright © the authors, 2014. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License ( ), which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.
Description: The file associated with this record is under a 12-month embargo from publication in accordance with the publisher's self-archiving policy. Following the embargo the file has the rights listed above.
Appears in Collections:Published Articles, Dept. of Cardiovascular Sciences

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