CvLPRIT
Trial question
What is the role of complete revascularization in patients presenting for primary PCI with multivessel disease?
Study design
Multi-center
Open label
RCT
Population
Characteristics of study participants
19.0% female
81.0% male
N = 296
296 patients (56 female, 240 male).
Inclusion criteria: patients found to have multivessel disease while undergoing primary PCI for ST-segment elevation MI.
Key exclusion criteria: age < 18 years; clear indication for, or contraindication to, multi vessel P-PCI; previous Q wave MI; patients with prior CABG; cardiogenic shock; VSD or moderate/severe MR; CKD; suspected or confirmed thrombosis of a previously stented artery.
Interventions
N=150 complete percutaneous coronary revascularization (including all non-infarct-related arteries).
N=146 IRA-only percutaneous coronary revascularization (infarct related artery only).
Primary outcome
Rate of all-cause death, recurrent MI, heart failure, and ischemia-driven revascularization within 12 months
10%
21.2%
21.2 %
15.9 %
10.6 %
5.3 %
0.0 %
Complete percutaneous coronary
revascularization
IRA-only percutaneous coronary
revascularization
Significant
decrease ▼
NNT = 8
Significant decrease in the rate of all-cause death, recurrent MI, HF, and ischemia-driven revascularization within 12 months (10% vs. 21.2%; HR 0.45, 95% CI 0.24 to 0.84).
Secondary outcomes
No significant difference in death from any cause at 12 months (1.3% vs. 4.1%; HR 0.32, 95% CI 0.06 to 1.6).
No significant difference in recurrent MI at 12 months (1.3% vs. 2.7%; HR 0.48, 95% CI 0.09 to 2.62).
No significant difference in repeat revascularization at 12 months (4.7% vs. 8.2%; HR 0.55, 95% CI 0.22 to 1.39).
Safety outcomes
No significant differences in stroke, major bleeding, or contrast-induced nephropathy.
Conclusion
In patients found to have multivessel disease while undergoing primary PCI for ST-segment elevation MI, complete percutaneous coronary revascularization was superior to IRA-only percutaneous coronary revascularization with respect to the rate of all-cause death, recurrent myocardial infarction, HF, and ischemia-driven revascularization within 12 months.
Reference
Gershlick AH, Khan JN, Kelly DJ et al. Randomized trial of complete versus lesion-only revascularization in patients undergoing primary percutaneous coronary intervention for STEMI and multivessel disease: the CvLPRIT trial. J Am Coll Cardiol. 2015 Mar 17;65(10):963-72.
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