CvLPRIT: Noninfarct artery PCI at admission improved outcomes

BARCELONA, Spain — Complete percutaneous revascularization at admission was associated with a 55% reduction in MACE compared with treating only the index lesion, according to findings from the CvLPRIT study presented here.

“There are now two trials indicating a signal that in mutivessel disease, primary PCI of significant stenoses in noninfarct-related vessels at admission improves clinical outcomes,” Anthony H. Gershlick, MD, investigator of the CvLPRIT trial, told Cardiology Today’s Intervention.

According to Gershlick, of the University Hospitals of Leicester, United Kingdom, patients in CvLPRIT were stratified based on whether the infarct was anterior or non-anterior and whether symptom-to-balloon time was more or less than 3 hours.

One-year MACE — including mortality, recurrent MI, HF and ischemia-driven revascularization — served as the primary outcome measure. The study included 146 patients in the index lesion only group and 150 patients in the complete revascularization group.

“Over 12 months, the Kaplan Meier curve suggests about a 20% incidence of MACE if you treat the infarct-related artery only. If you treat with complete revascularization at admission, you get a significant reduction of 55% in MACE,” Gershlick said at a press conference.

Regarding the time to first event, although the numbers were small and therefore nonsignificant, Gershlick said that reductions were reported for total revascularization in all components of the primary endpoint — not only in repeat revascularization.

Complete revascularization also yielded an HR of 0.45 (95% CI, 0.19-1.04; P=.055) for MACE at 30 days compared with treating the index lesion only.

Gershlick added that safety outcomes indicated no differences between the two groups in terms of stroke, major bleeding and contrast-induced nephropathy.

“We should point out that the hard events — death, MI and heart failure — were similarly reduced,” Gershlick said. “There is no reason to only do PCI to the infarct-related artery.”

In-hospital treatment of noninfarct-related arteries during primary PCI improves clinical outcomes, Gershlick concluded. “Our results suggest that this strategy may need to be considered by future STEMI guideline committees, particularly because our results mirror somewhat the PRAMI trial,” he said.

Eligible participants in the study had suspected or proven acute MI; significant ST elevation or left bundle branch block on ECG; symptom onset <12 hours prior; were scheduled for primary PCI for clinical reasons; had multivessel CAD defined as infarct-related artery plus at least one noninfarct-related epicardial artery with at least one lesion deemed angiographically significant (defined as >70% diameter stenosis in one plane or >50% in two planes); had major artery (>2 mm) epicardial coronary artery or branch (>2 mm); and were suitable for stent implantation, according to Gershlick. – by Rob Volansky

For more information:

Gershlick AH. Hot Line IV: Myocardial Infarction. Presented at: the European Society of Cardiology Congress; Aug. 30-Sept. 3, 2014; Barcelona, Spain.

Disclosure: Gershlick reports no relevant financial disclosures.