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dc.contributor.authorKelly, Damian
dc.date.accessioned2020-01-31T14:21:04Z
dc.date.available2020-01-31T14:21:04Z
dc.date.issued2019-12
dc.identifier.citationJ Am Coll Cardiol. 2019 Dec 24;74(25):3083-3094. doi: 10.1016/j.jacc.2019.10.033.en
dc.identifier.urihttp://hdl.handle.net/20.500.12904/829
dc.description.abstractBACKGROUND: 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).en
dc.language.isoenen
dc.subjectST-Elevationen
dc.subjectComplete Revascularisation
dc.subjectMultivessel Disease
dc.subjectMyocardial Infarction
dc.subjectNoninfarct-Related Lesion
dc.subjectPrimary Percutaneous Coronary Intervention
dc.titleLong-Term Follow-Up of Complete Versus Lesion-Only Revascularization inen
dc.typeArticleen


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