A randomised trial of target-vessel versus multi-vessel revascularisation in ST-elevation myocardial infarction: major adverse cardiac events during long-term follow-up

Politi, Luigi; Sgura, Fabio; Rossi, Rosario; Monopoli, Daniel; Guerri, E; Leuzzi, Chiara; Bursi, Francesca; Sangiorgi, Giuseppe; Modena, Maria Grazia

doi:10.1136/hrt.2009.177162

Cited by 336 publications

(306 citation statements)

References 24 publications

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“…However, in this study the additional PCI was performed without ischaemia detection. Our findings differ from a more recent randomised trial by Politi et al [5] They showed that culprit vessel-only angioplasty was associated with the highest rate of longterm MACE compared with multi-vessel treatment. The patients scheduled for staged revascularisation (SR) experienced a similar rate of MACE compared with patients undergoing complete simultaneous (CR) treatment of nonculprit lesion.…”

Section: Discussioncontrasting

confidence: 57%

“…It is not well known whether the long-term prognosis of patients with MVD can be improved by early additional revascularisation. Results from a recent randomised, not ischaemia guided, study have suggested that the rate of long-term MACE is reduced in patients with early complete revascularisation compared with culprit vesselonly angioplasty [5].…”

Section: Introductionmentioning

confidence: 99%

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Treatment of non-culprit lesions detected during primary PCI: long-term follow-up of a randomised clinical trial

et al. 2012

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Background There are conflicting data regarding optimal treatment of non-culprit lesions detected during primary percutaneous coronary intervention (PCI) in patients with ST-elevation myocardial infarction (STEMI) and multivessel disease (MVD). We aimed to investigate whether ischaemia-driven early invasive treatment improves the long-term outcome and prevents major adverse cardiac events (MACE). Methods 121 patients with at least one non-culprit lesion were randomised in a 2:1 manner, 80 were randomised to early fractional flow reserve (FFR)-guided PCI (invasive group), and 41 to medical treatment (conservative group). The primary endpoint was MACE at 3 years.Results Three-year follow-up was available in 119 patients (98.3 %). There was no significant difference in all-cause mortality between the invasive and conservative strategy, 4 patients (3.4 %) died, all in the invasive group (P00.29). Re-infarction occurred in 14 patients (11.8 %) in the invasive group versus none in the conservative group (p00.002). Re-PCI was performed in 7 patients (8.9 %) in the invasive group and in 13 patients (32.5 %) in the conservative group (P00.001). There was no difference in MACE between these two strategies (35.4 vs 35.0 %, p00.96). Conclusions In STEMI patients with MVD, early FFRguided additional revascularisation of the non-culprit lesion did not reduce MACE at three-year follow-up compared with a more conservative strategy. The rate of MACE in the invasive group was predominantly driven by death and re-infarction, whereas in the conservative group the rate of MACE was only driven by repeat interventions.

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Section: Discussioncontrasting

confidence: 57%

Section: Introductionmentioning

confidence: 99%

Treatment of non-culprit lesions detected during primary PCI: long-term follow-up of a randomised clinical trial

et al. 2012

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“…The findings of this study are, however, consistent with previous clinical evidence, which suggests that complete revascularization reduces future MACEs [7,9,30,31] (with associated reduced hospital re-admission costs) and also improves quality of life (according to the Seattle Angina Questionnaire) [32]. There are few well-conducted economic analyses of P-PCI, especially in the context of randomized trials.…”

Section: Comparisons With Other Studiessupporting

confidence: 71%

Economic Evaluation of Complete Revascularization for Patients with Multivessel Disease Undergoing Primary Percutaneous Coronary Intervention

et al. 2017

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Objectives: To determine the cost-effectiveness of complete revascularization at index admission compared with infarct-related artery (IRA) treatment only, in patients with multivessel disease undergoing primary percutaneous coronary intervention (P-PCI) for ST-segment elevation myocardial infarction. Methods: An economic evaluation of a multicenter randomized trial was conducted, comparing complete revascularization at index admission to IRA-only P-PCI in patients with multivessel disease (12-month follow-up). Overall hospital costs (costs for P-PCI procedure(s), hospital length of stay, and any subsequent re-admissions) were estimated. Outcomes were major adverse cardiac events (MACEs, a composite of all-cause death, recurrent myocardial infarction, heart failure, and ischemia-driven revascularization) and quality-adjusted life-years (QALYs) derived from the three-level EuroQol five-dimensional questionnaire. Multiple imputation was undertaken. The mean incremental cost and effect, with associated 95% confidence intervals, the incremental costeffectiveness ratio, and the cost-effectiveness acceptability curve were estimated. Results: On the basis of 296 patients, the mean incremental overall hospital cost for complete revascularization was estimated to be -£215.96 (-£1390.20 to £958.29), compared with IRAonly, with a per-patient mean reduction in MACEs of 0.170 (0.044 to 0.296) and a QALY gain of 0.011 (À0.019 to 0.041). According to the cost-effectiveness acceptability curve, the probability of complete revascularization being cost-effective was estimated to be 72.0% at a willingness-to-pay threshold value of £20,000 per QALY. Conclusions: Complete revascularization at index admission was estimated to be more effective (in terms of MACEs and QALYs) and cost-effective (overall costs were estimated to be lower and complete revascularization thereby dominated IRA-only). There was, however, some uncertainty associated with this decision.

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“…A small randomized trial was stopped prematurely due to slow recruitment [31]. In a recent randomized trial [32], 214 consecutive patients with STEMI and multivessel CAD undergoing primary angioplasty were randomized before the first angioplasty to one of three strategies: 1) culprit vessel angioplasty only; 2) staged revascularization; and 3) simultaneous treatment of nonIRAs. During a mean follow-up of 2.5 years, 42 (50.0%) patients in the 'culprit vessel angioplasty only' group experienced at least one major adverse cardiac event, 13 (20.0%) had an event in the staged revascularization group, and 15 (23.1%) in the simultaneous treatment of non-IRAs group (p < 0.001).…”

Section: Discussionmentioning

confidence: 99%

Impact of multivessel disease on infarct size among STEMI patients undergoing primary angioplasty

Luca¹,

Parodi²,

Sciagrà³

et al. 2014

Atherosclerosis

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a b s t r a c tBackground: Although primary angioplasty achieves Thrombolysis In Myocardial Infarction (TIMI) 3 flow in most patients with ST-elevation myocardial infarction, epicardial recanalization does not guarantee optimal perfusion in a large proportion of patients. Multivessel disease has been demonstrated to be associated with impaired survival, however its impact on infarct size has not been largely investigated, that therefore is the aim of the current study.

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A randomised trial of target-vessel versus multi-vessel revascularisation in ST-elevation myocardial infarction: major adverse cardiac events during long-term follow-up

Cited by 336 publications

References 24 publications

Treatment of non-culprit lesions detected during primary PCI: long-term follow-up of a randomised clinical trial

Treatment of non-culprit lesions detected during primary PCI: long-term follow-up of a randomised clinical trial

Economic Evaluation of Complete Revascularization for Patients with Multivessel Disease Undergoing Primary Percutaneous Coronary Intervention

Impact of multivessel disease on infarct size among STEMI patients undergoing primary angioplasty

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