TY - JOUR
T1 - Long-Term Follow-Up of Complete Versus Lesion-Only Revascularization in STEMI and Multivessel Disease: The CvLPRIT Trial
AU - Gershlick, Anthony H.
AU - Banning, Amerjeet S.
AU - Parker, Emma
AU - Wang, Duolao
AU - Budgeon, Charley A.
AU - Kelly, Damian J.
AU - Kane, Peter O.
AU - Dalby, Miles
AU - Hetherington, Simon L.
AU - McCann, Gerry P.
AU - Greenwood, John P.
AU - Curzen, Nick
PY - 2019/12/24
Y1 - 2019/12/24
N2 - 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).
AB - 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).
KW - complete revascularization
KW - multivessel disease
KW - myocardial infarction
KW - noninfarct-related lesion
KW - primary percutaneous coronary intervention
KW - ST-elevation
U2 - 10.1016/j.jacc.2019.10.033
DO - 10.1016/j.jacc.2019.10.033
M3 - Article
SN - 0735-1097
VL - 74
SP - 3083
EP - 3094
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
IS - 25
ER -