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PRAGUE 13: Multivessel PCI failed to best culprit-vessel PCI after STEMI

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New data from the PRAGUE 13 trial presented at EuroPCR demonstrate no difference in favor of multivessel PCI over culprit-only primary PCI in patients with STEMI.

Ota Hlinomaz, MD, PhD, from St. Anne University Hospital in Brno, Czech Republic, and colleagues studied two management strategies in patients with STEMI who had 70% or greater stenosis in a nonculprit artery.

The study included 106 patients who underwent complete revascularization of all significant stenoses in noninfarct coronary arteries — which Hlinomaz said involved a staged PCI performed from day 3 to 40 after intervention — and 108 patients who received conservative management based on guideline-recommended treatment.

The primary composite endpoint included all-cause death, nonfatal MI and stroke, which occurred in 16% of patients in the multivessel PCI group vs. 13.9% in the conservative therapy group (HR = 1.35; 95% CI, 0.66-2.74). The all-cause mortality rate was 5.7% for the multivessel PCI group vs. 6.5% for the conservative therapy group (HR = 0.91; 95% CI, 0.30-2.70), the rate of nonfatal MI was 10.4% vs. 7.4%, respectively (HR = 1.71; 95% CI, 0.66-4.41) and the rate of stroke was 0% vs. 2.8%, respectively. Hlinomaz also reported that 3.8% of patients in the multivessel PCI group had periprocedural infarctions with good prognosis.

Other results indicated no significant difference between the two groups in hospitalization for unstable angina (P = .193) or hospitalization for HF (P = .672), CV mortality (P = .699) and revascularization for a noninfarct artery (P = .089).

“This trial found no difference, not even a trend, favoring staged multivessel PCI over culprit-only primary PCI in STEMI,” Hlinomaz said during a presentation. “Larger trials are needed to clarify the revascularization strategy in STEMI patients with multivessel disease.” – by Rob Volansky

Reference:

Hlinomaz O, et al. Hot Line: Late-Breaking Trials and Innovations. Presented at: EuroPCR; May 19-22, 2015; Paris.

Disclosure: Hlinomaz reports no relevant financial disclosures.