Author + information
- Received August 13, 2019
- Revision received October 1, 2019
- Accepted October 6, 2019
- Published online December 16, 2019.
- Anthony H. Gershlick, MBBSa,∗ (, )@UoLCVS,
- Amerjeet S. Banning, BSc (Hons), MBBSa,
- Emma Parker, RCNa,
- Duolao Wang, PhDb,
- Charley A. Budgeon, PhDa,
- Damian J. Kelly, MB ChB, MDc,
- Peter O. Kane, MBBS, MDd,
- Miles Dalby, MBBS, MDe,
- Simon L. Hetherington, MB ChB, MDf,
- Gerry P. McCann, MB ChB, MDa,
- John P. Greenwood, MB ChB, PhDg and
- Nick Curzen, BM (Hons), PhDh
- aDepartment of Cardiovascular Sciences, University of Leicester and Cardiovascular Theme, NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, United Kingdom
- bDepartment of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- cDepartment of Cardiology, Royal Derby Hospital, Derby, United Kingdom
- dDepartment of Cardiology, Royal Bournemouth and Christchurch Hospitals, Bournemouth, United Kingdom
- eDepartment of Cardiology, Royal Brompton & Harefield NHS Foundation Trust, Harefield Hospital, Middlesex, London, United Kingdom
- fDepartment of Cardiology, Kettering General Hospital, Rothwell Road, Kettering, United Kingdom
- gMultidisciplinary Cardiovascular Research Centre & The Division of Biomedical Imaging, Leeds Institute of Cardiovascular & Metabolic Medicine, Leeds University, Leeds, United Kingdom
- hDepartment of Cardiology, University Hospital Southampton, and University of Southampton, Southampton, United Kingdom
- ↵∗Address for correspondence:
Dr. Anthony H. Gershlick, Department of Cardiovascular Sciences, University of Leicester and Cardiovascular Theme, NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Groby Road, Leicester, LE3 9QP, United Kingdom.
Background Randomized trials have shown that complete revascularization in patients with ST-segment elevation myocardial infarction (MI) with multivessel disease results in lower major adverse cardiovascular events (MACE) (all-cause death, MI, ischemia-driven revascularization, heart failure).
Objectives The goal of this study was to determine whether the benefits of complete revascularization are sustained long-term and their impact on hard endpoints.
Methods CvLPRIT (Complete versus Lesion-only Primary PCI Trial) was a randomized trial of complete inpatient revascularization versus infarct-related artery revascularization only at the index admission. Randomized patients have been followed longer-term. The components of the original primary endpoint were collected from physical and electronic patient records, and from local databases for all readmissions.
Results The median follow-up (achieved in >90% patients) from randomization to first event or last follow-up was 5.6 years (0.0 to 7.3 years). The primary MACE endpoint rate at this time point was 24.0% in the complete revascularization group but 37.7% of the infarct-related artery–only group (hazard ratio: 0.57; 95% confidence interval: 0.37 to 0.87; p = 0.0079). The composite endpoint of all-cause death/MI was 10.0% in the complete revascularization group versus 18.5% in the infarct-related artery–only group (hazard ratio: 0.47; 95% confidence interval: 0.25 to 0.89; p = 0.0175). In a landmark analysis (from 12 months to final follow-up), there was no significant difference between MACE, death/MI, and individual components of the primary endpoint.
Conclusions Long-term follow-up of the CvLPRIT trial shows that the significantly lower rate of MACE in the complete revascularization group, previously seen at 12 months, is sustained to a median of 5.6 years. A significant difference in composite all-cause death/MI favoring the complete revascularization was also observed. (Complete versus Lesion-only Primary PCI Trial; ISRCTN70913605)
- complete revascularization
- multivessel disease
- myocardial infarction
- noninfarct-related lesion
- primary percutaneous coronary intervention
The CvLPRIT trial was funded by the British Heart Foundation (SP/10/001) with support from the National Institute for Health Research (NIHR) Comprehensive Local Research Networks, in particular, by the NIHR infrastructure at Leicester Leeds. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR, or the Department of Health. The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received August 13, 2019.
- Revision received October 1, 2019.
- Accepted October 6, 2019.
- 2019 American College of Cardiology Foundation
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