Multivessel coronary disease diagnosed at the time of primary PCI for STEMI: complete revascularisation versus conservative strategy. Prague-13 trial

Česká verzia

Authors: O. Hlinomaz ¹; L. Groch ¹; K. Poloková ¹; F. Lehar ¹; T. Vekov ²; R. Petkov ²; M. Stojnev ²; M. Gřiva ³; J. Sitár ¹; M. Rezek ¹; M. Novák ¹; J. Seménka ¹; N. Penkov ²
Authors place of work: I. interní kardioangiologická klinika LF MU a FN u sv. Anny v Brně ¹; Bulharský kardiologický institut, Sofie, Bulharsko ²; Krajská nemocnice T. Bati, Zlín ³
Published in the journal: Kardiol Rev Int Med 2015, 17(3): 214-220
Category: Cardiology Review

Summary

Primary percutaneous coronary intervention (PPCI) in the occlusion or significant stenosis of an infarct (culprit) artery is a method of choice in the treatment of acute myocardial infarction with ST segment elevation (STEMI). The purpose of this trial was to identify the optimal management of patients with STEMI treated by PPCI who have at least one significant (≥ 70%) stenosis of a non-culprit coronary artery. Between 2009 and 2013, 214 patients with STEMI and multivessel coronary disease, successfully treated with infarct-related artery PPCI, were enrolled into the trial in six centres. One hundred and eight patients were randomly assigned to a non-PCI group and 106 to a staged PCI group. Patients with limiting angina pectoris present for more than 1 month prior to STEMI were excluded from the trial, among others. There were no significant differences in the baseline characteristics between both groups. The primary endpoint of the study was the incidence of the combined endpoint of all-cause mortality, nonfatal myocardial infarction and stroke during the follow-up in the group of patients treated with staged PCI in comparison with patients treated conservatively. An intention-to-treat analysis was used. Patients were followed for 38 months (median). The composite primary endpoint appeared in 15 (13.9%) patients in the non-PCI group and 17 (16.0%) in the PCI group; the hazard ratio in staged PCI group being 1.35; 95% CI 0.66–2.74; p=0.407. The hazard ratio for all-cause mortality was 0.91 (95% CI 0.30–2.70) and for nonfatal myocardial infarction 1.71 (95% CI 0.66–4.41) in the staged PCI group. Nineteen (17.6%) patients from the non-PCI group had a PCI of non-culprit coronary artery during the follow-up due to progression of angina symptoms or acute myocardial infarction. Only 13 (6.1%) patients had a non-culprit artery stenosis of ≥95% and the average non-culprit coronary artery stenosis diameter was 80%. This trial found no difference (not even a trend) favouring staged multivessel PCI over culprit-only PPCI in STEMI patients. Larger trials are needed to clarify the revascularisation strategy in STEMI patients with multivessel disease.

Keywords:
primary PCI – acute myocardial infarction – multivessel coronary disease – revascularisation

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