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Title: The complete versus lesion only primary PCI trial-cardiovascular MRI substudy (CVLPRIT-CMR)
Other Titles: CvLPRIT CMR substudy
Authors: Khan, J. N.
Greenwood, J. P.
Nazir, S. A.
Dalby, M.
Curzen, N.
Hetherington, S.
Kelly, D. J.
Blackman, D.
Peebles, C.
Wong, J.
Swanton, H.
Flather, M.
Gershlick, Anthony H.
McCann, Gerald P.
First Published: 16-Mar-2015
Publisher: Elsevier for American College of Cardiology
Citation: Journal of the American College of Cardiology, 2015, 65(10) Supplement, A17
Abstract: Background: The PRAMI and CvLPRIT trials have shown that a strategy of complete in-hospital revascularization (CR) reduces major adverse cardiovascular events compared to infarct-related artery (IRA) only revascularization at the time of PPCI. The mechanism(s) leading to benefit are unclear and there is concern that CR may cause additional PCI-related infarcts. The aim of the CvLPRIT-CMR substudy was to assess infarct size (IS), myocardial salvage and reversible ischemia in patients randomized to CR or IRA only PPCI. Methods: CvLPRIT-CMR recruited 203 patients in 7 UK centres. Follow-up was completed in May 2014. Acute CMR was performed 24-96 hours after revascularization. Follow-up CMR at 9 months assessed reversible ischaemia and final IS in 164 patients. The primary endpoint was IS (%LV mass) on acute CMR and the study had 81% power to detect a 4% difference with 100 patients in each group. Results: Baseline, angiographic and CMR results are summarized in Table 1. The CR and IRA groups were well matched. There was no significant differences in IS, myocardial salvage index or ejection fraction between groups. At follow-up reversible perfusion defects occured in 21% of patients in both groups, and ischemic burden was small and comparable between groups, as was final IS. Conclusion: CR at the time of PPCI was not associated with increased IS compared to an IRA only strategy. Reducing reversible ischemia is unlikely to be the primary mechanism resulting in improved clinical outcomes following CR at the time of PPCI.
DOI Link: 10.1016/S0735-1097(15)60017-1
ISSN: 0735-1097
eISSN: 1558-3597
Type: Journal Article
Appears in Collections:Published Articles, Dept. of Cardiovascular Sciences

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