Author + information
- Received November 20, 2014
- Revision received December 16, 2014
- Accepted December 22, 2014
- Published online March 17, 2015.
- Anthony H. Gershlick, MBBS∗∗ (, )
- Jamal Nasir Khan, MB ChB∗,
- Damian J. Kelly, MB ChB, MD†,
- John P. Greenwood, MB ChB, PhD‡,§,
- Thiagarajah Sasikaran, BSc, PhD‖,
- Nick Curzen, BM, PhD¶,
- Daniel J. Blackman, MD§,
- Miles Dalby, MBBS, MD#,
- Kathryn L. Fairbrother, BA∗∗,
- Winston Banya, MSc††,
- Duolao Wang, PhD‡‡,
- Marcus Flather, MB BS§§,
- Simon L. Hetherington, MB ChB, MD‖‖,
- Andrew D. Kelion, BM BCh, DM¶¶,
- Suneel Talwar, MB BS, MD##,
- Mark Gunning, MD∗∗∗,
- Roger Hall, MD§§,
- Howard Swanton, MB BChir, MD††† and
- Gerry P. McCann, MB ChB, MD∗
- ∗Department of Cardiovascular Sciences, University of Leicester and National Institute of Health Research Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital, Leicester, United Kingdom
- †Department of Cardiology, Royal Derby Hospital, Derby, United Kingdom
- ‡Multidisciplinary Cardiovascular Research Centre and the Division of Cardiovascular and Diabetes Research, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom
- §Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
- ‖Clinical Trials and Evaluation Unit, Royal Brompton & Harefield NHS Foundation Trust and Imperial College London, London, United Kingdom
- ¶University Hospital Southampton and Faculty of Medicine, University of Southampton, Southampton, United Kingdom
- #Royal Brompton & Harefield NHS Trust, London, United Kingdom
- ∗∗University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
- ††National Institute for Health Research Cardiovascular Biomedical Research Unit, Royal Brompton & Harefield NHS Trust, London, United Kingdom
- ‡‡Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- §§Norfolk and Norwich University Hospitals NHS Foundation Trust and Norwich Medical School, University of East Anglia Norwich, United Kingdom
- ‖‖Kettering General Hospital, Kettering, United Kingdom
- ¶¶Oxford Heart Centre, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford, United Kingdom
- ##Royal Bournemouth Hospital, Bournemouth, United Kingdom
- ∗∗∗Royal Stoke University Hospital, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, Staffordshire, United Kingdom
- †††The Heart Hospital, University College London Hospitals, London, United Kingdom
- ↵∗Reprint requests and correspondence:
Dr. Anthony H. Gershlick, Department of Cardiovascular Sciences, University of Leicester and NIHR Leicester Cardiovascular Biomedical Research Unit, University Hospitals of Leicester NHS Trust, Glenfield Hospital, Groby Road Site, Leicester LE3 9QP, United Kingdom.
Background The optimal management of patients found to have multivessel disease while undergoing primary percutaneous coronary intervention (P-PCI) for ST-segment elevation myocardial infarction is uncertain.
Objectives CvLPRIT (Complete versus Lesion-only Primary PCI trial) is a U.K. open-label randomized study comparing complete revascularization at index admission with treatment of the infarct-related artery (IRA) only.
Methods After they provided verbal assent and underwent coronary angiography, 296 patients in 7 U.K. centers were randomized through an interactive voice-response program to either in-hospital complete revascularization (n = 150) or IRA-only revascularization (n = 146). Complete revascularization was performed either at the time of P-PCI or before hospital discharge. Randomization was stratified by infarct location (anterior/nonanterior) and symptom onset (≤3 h or >3 h). The primary endpoint was a composite of all-cause death, recurrent myocardial infarction (MI), heart failure, and ischemia-driven revascularization within 12 months.
Results Patient groups were well matched for baseline clinical characteristics. The primary endpoint occurred in 10.0% of the complete revascularization group versus 21.2% in the IRA-only revascularization group (hazard ratio: 0.45; 95% confidence interval: 0.24 to 0.84; p = 0.009). A trend toward benefit was seen early after complete revascularization (p = 0.055 at 30 days). Although there was no significant reduction in death or MI, a nonsignificant reduction in all primary endpoint components was seen. There was no reduction in ischemic burden on myocardial perfusion scintigraphy or in the safety endpoints of major bleeding, contrast-induced nephropathy, or stroke between the groups.
Conclusions In patients presenting for P-PCI with multivessel disease, index admission complete revascularization significantly lowered the rate of the composite primary endpoint at 12 months compared with treating only the IRA. In such patients, inpatient total revascularization may be considered, but larger clinical trials are required to confirm this result and specifically address whether this strategy is associated with improved survival. (Complete Versus Lesion-only Primary PCI Pilot Study [CvLPRIT]; ISRCTN70913605)
The British Heart Foundation funded the study, with additional support from the National Institute of Health Research and the Medical Research Council for the cardiac magnetic resonance substudy. Funding organizations had no role in the conduct, analysis, or reporting of the study. Dr. Gershlick has received lecture fees and advisory board fees from Abbott Vascular, The Medicines Company, and AstraZeneca. Dr. Curzen has received research grants from St. Jude Medical, Haemonetics, and Medtronic; honoraria from St. Jude Medical, Haemonetics, Abbott Vascular, and HeartFlow; and nonfinancial support from Volcano outside of the current work. Dr. Dalby has served as a consultant for AstraZeneca, Boston Scientific, and Medtronic; and has received research grants from Abbott Vascular, Lilly DS Alliance, and Sanofi. Dr. Flather has served on advisory and speaker panels for AstraZeneca and Menarini International outside the current work. Dr. McCann has received research grants from Servier, Novartis, and Menarini International outside the current work. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received November 20, 2014.
- Revision received December 16, 2014.
- Accepted December 22, 2014.
- The Authors