Complete Versus culprit-Lesion only PRimary PCI Trial (CVLPRIT): a multicentre trial testing management strategies when multivessel disease is detected at the time of primary PCI: rationale and design

Kelly, Damian J.; McCann, Gerry P; Blackman, Daniel J.; Curzen, Nick; Dalby, Miles; Greenwood, John P; Fairbrother, Kathryn L.; Shipley, Lorraine; Kelion, Andrew; Heatherington, Simon; Khan, Jamal Nasir; Nazir, Sheraz A; Alahmar, Albert; Flather, Marcus; Swanton, Howard; Schofield, Peter M.; Gunning, Mark; Hall, Roger; Gershlick, Anthony

doi:10.4244/eijv8i10a183

Cited by 45 publications

(29 citation statements)

References 33 publications

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“…For example, patients in the complete revascularization group had more males, had higher door-to-balloon time, and were more likely to suffer from heart failure than those in the culprit artery-only PCI group. These findings are consistent with many other many randomized control studies [2,9,[11][12][13]] the use of percutaneous coronary intervention (PCI The current study results showed that patients in the complete PCI group had 49% lower MACE rate at the mean follow-up of 28 months compared to patients in culprit artery-only PCI group. This finding agrees with the systematic reviews [4,8].…”

Section: R E T R a C T E D A R T I C L Esupporting

confidence: 92%

Comparative Effectiveness of Complete Revascularization versus Infarct Related Artery-only Percutaneous Coronary Revascularization for Multivessel Disease after ST-Segment Elevation Myocardial Infarction

Jayaraj¹,

Abrahamyan²,

Demirchyan³

2016

ICFJ

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Objectives: The purpose of this study was to evaluate the event free survival from major adverse cardiac events (MACE) for ST-segment elevation myocardial infarction (STEMI) patients with multivessel disease as a function of whether they underwent infarct-related artery (IRA) only percutaneous coronary intervention (PCI) or complete revascularization at index admission.Background: The optimal management of patients with STEMI and multivessel disease while undergoing primary percutaneous coronary intervention (P-PCI) is uncertain.Methods and Results: STEMI patients with multivessel disease undergoing P-PCI between April 1, 2012, and March 31, 2014, were subdivided into those who underwent in-hospital complete revascularization (n= 150) or IRA-only revascularization (n = 156). Complete revascularization was performed during the index admission of P-PCI. The primary endpoint was a composite of all-cause death, recurrent myocardial infarction (MI), heart failure, and ischemia-driven revascularization within 24 months. Patient groups were differed at baseline by gender and prevalence of heart failure. The average door-to-balloon time was significantly higher in the complete revascularization group. The primary endpoint occurred in 11.0% of the complete revascularization group versus 23% in the IRA-only revascularization group (hazard ratio: 0.51; 95% confidence interval: 0.34 to 0.93; p =0.039). There was a significant reduction in death, a non-significant reduction in all primary endpoint components was seen. <span style="font-size: 12.0pt; line-height: 115%; font-family: 'Times New Roman','serif'; mso-fareast-font-family: 'Times New Roman'; mso-ansi-language: EN-US; mso-fareast-language: EN-US; mso-bidi-language: EN-US;">Conclusions:<span style="font-size: 12.0pt; line-height: 115%; font-family: 'Times New Roman','serif'; mso-fareast-font-family: 'Times New Roman'; mso-ansi-language: EN-US; mso-fareast-language: EN-US; mso-bidi-language: EN-US;"> In patients presenting for P-PCI with multivessel disease, index admission complete revascularization significantly lowered the rate of the primary composite endpoint at 24 months compared with treating only the IRA.

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Section: R E T R a C T E D A R T I C L Esupporting

confidence: 92%

Comparative Effectiveness of Complete Revascularization versus Infarct Related Artery-only Percutaneous Coronary Revascularization for Multivessel Disease after ST-Segment Elevation Myocardial Infarction

Jayaraj¹,

Abrahamyan²,

Demirchyan³

2016

ICFJ

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“…28,29 This study found that a strategy of complete revascularization before discharge was associated with reduced composite risk of death, recurrent MI, heart failure, or ischemia-driven revascularization at 30 days (HR, 0.45; 95% CI, 0.24-0.84; P=0.009) and the results were sustained ≤1 year. However, there was no statistical significance when each component was analyzed separately.…”

Section: Discussionmentioning

confidence: 65%

Culprit Vessel Versus Multivessel Intervention at the Time of Primary Percutaneous Coronary Intervention in Patients With ST-Segment–Elevation Myocardial Infarction and Multivessel Disease

Iqbal

Ilsley

Kabir

et al. 2014

Circ: Cardiovascular Quality and Outcomes

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Background-It is estimated that up to two thirds of patients presenting with ST-segment-elevation myocardial infarction have multivessel disease. The optimal strategy for treating nonculprit disease is currently under debate. This study provides a real-world analysis comparing a strategy of culprit-vessel intervention (CVI) versus multivessel intervention at the time of primary percutaneous coronary intervention in patients with ST-segment-elevation myocardial infarction. Methods and Results-We compared CVI versus multivessel intervention in 3984 patients with multivessel disease undergoing primary percutaneous coronary intervention between 2004 and 2011 at all 8 tertiary cardiac centers in London. Multivariable-adjusted models were built to determine independent predictors for in-hospital major adverse cardiovascular events (MACEs) and all-cause mortality at 1 year. To reduce confounding and bias, propensity score methods were used. CVI was associated with reduced in-hospital MACE (4.6% versus 7.2%; P=0.010) and mortality at 1 year (7.4% versus 10.1%; P=0.031). CVI was an independent predictor for reduced in-hospital MACE (odds ratio, Key Words: culprit artery ◼ multivessel percutaneous coronary intervention ◼ primary percutaneous coronary intervention ◼ ST-segment elevation myocardial infarction

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“…1,10 A network meta-analysis has suggested that multivessel staged PCI may be associated with a better outcome than multivessel primary PCI, 11 but such data are still insufficient to inform a recommendation with regard to the optimal timing of non-culprit vessel PCI. [12][13][14] In fact, a more recent meta-analysis showed that CR at the index procedure or as a staged procedure -whether during hospitalisation or after discharge -was associated with a reduction in the risk of adverse events, although the effect was mostly due to a reduction in the risk of urgent revascularisation. There was no difference between various strategies in the risk of all-cause mortality and spontaneous reinfarction at a median of 25 months.…”

Section: 210mentioning

confidence: 99%

Is Complete Revascularisation Mandated for all Patients with Multivessel Coronary Artery Disease?

Caterina

Innocentiis

Zimarino

2017

Interventional Cardiology Review

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CoronaryMultivessel coronary artery disease (MVCAD) is defined by the presence of ≥50 % diameter stenosis of two or more epicardial coronary arteries.The presence of MVCAD indicates poorer prognosis and a significantly higher mortality than single-vessel disease. In MVCAD, revascularisation can be achieved by either percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG).1,2 A comprehensive definition of the adequacy of myocardial revascularisation should take into account the size of the vessel, the angiographic and functional severity of the lesion, and the viability of the myocardial territory. 3 Accordingly, anatomic and functional complete revascularisation (CR) are not always synonymous. Generally, the anatomic CR is defined by treatment of all ≥50 % stenosis in vessels of ≥1.5 mm diameter, whereas functional CR is defined by treatment of all lesions assessed as functionally relevant (with both invasive or non-invasive methods) in the presence of myocardial viability in the dependent territory, see Table 1. 3At present, only a few trials have been specifically designed to directly evaluate the adequacy of revascularisation. Current literature, mostly relying on meta-analyses of non-randomised observational studies, 4,5 lists the adequacy of revascularisation among factors that should guide the choice of treatment strategy. In most patients with MVCAD, the main advantage of CABG over PCI seems to be conferred by the achievement of more extensive revascularisation. Most of the difference in terms of the benefit of CABG over PCI seems to derive from patients who undergo incomplete revascularisation (IR). As documented in a recent patient-level analysis, long-term mortality was similar between patients undergoing CR with either PCI or CABG, whereas it was significantly higher with IR after PCI than CABG. 6Although much less invasive than traditional CABG, PCI yields lower rates of CR in patients with multiple coronary lesions. 7 IR can occasionally be implemented in addition to CABG in order to reduce complications, mainly when minimally invasive or off-pump surgery is attempted. AbstractIn multivessel coronary artery disease (MVCAD), myocardial revascularisation can be achieved by percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG), with complete revascularisation on all diseased coronary segments or with incomplete revascularisation on selectively targeted lesions. Complete revascularisation confers a long-term prognostic benefit, but is associated with a higher rate of periprocedural events compared with incomplete revascularisation. In most patients with MVCAD, the main advantage of CABG over PCI is conferred by the achievement of more extensive revascularisation. According to current international guidelines, PCI is generally preferred in single-vessel disease, low-risk MVCAD or isolated left main disease; whereas CABG is usually recommended in patients with complex two-vessel disease, most patients with three-vessel disease and/or non-isolate...

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Complete Versus culprit-Lesion only PRimary PCI Trial (CVLPRIT): a multicentre trial testing management strategies when multivessel disease is detected at the time of primary PCI: rationale and design

Cited by 45 publications

References 33 publications

Comparative Effectiveness of Complete Revascularization versus Infarct Related Artery-only Percutaneous Coronary Revascularization for Multivessel Disease after ST-Segment Elevation Myocardial Infarction

Comparative Effectiveness of Complete Revascularization versus Infarct Related Artery-only Percutaneous Coronary Revascularization for Multivessel Disease after ST-Segment Elevation Myocardial Infarction

Culprit Vessel Versus Multivessel Intervention at the Time of Primary Percutaneous Coronary Intervention in Patients With ST-Segment–Elevation Myocardial Infarction and Multivessel Disease

Is Complete Revascularisation Mandated for all Patients with Multivessel Coronary Artery Disease?

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