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Randomized trial of preventive angioplasty in myocardial infarction

David S Wald1, Joan K Morris, Nicholas J Wald

  • 1Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom. d.s.wald@qmul.ac.uk

The New England Journal of Medicine
|September 3, 2013
PubMed

Insights

Preventive percutaneous coronary intervention (PCI) in non-infarct arteries significantly lowers adverse cardiovascular events in ST-segment elevation myocardial infarction (STEMI) patients. This strategy is more effective than treating only the culprit artery during STEMI.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Acute Coronary Syndromes

Background:

  • ST-segment elevation myocardial infarction (STEMI) management typically involves percutaneous coronary intervention (PCI) of the infarct artery.
  • The benefit of performing PCI on non-infarct arteries with significant blockages (preventive PCI) in STEMI patients remains unclear.

Purpose of the Study:

  • To evaluate the efficacy of preventive PCI in non-infarct arteries for patients with STEMI and multivessel coronary artery disease.

Main Methods:

  • A randomized controlled trial involving 465 STEMI patients undergoing infarct-artery PCI.
  • Patients were assigned to either preventive PCI in non-infarct arteries or infarct-artery-only PCI.
  • The primary outcome was a composite of cardiac death, nonfatal myocardial infarction, or refractory angina.

Main Results:

  • Preventive PCI significantly reduced the primary outcome by 65% compared to infarct-artery-only PCI (9 vs. 23 events per 100 patients).
  • Hazard ratios favored preventive PCI for cardiac death (0.34), nonfatal myocardial infarction (0.32), and refractory angina (0.35).
  • The trial was stopped early due to conclusive evidence favoring preventive PCI.

Conclusions:

  • In STEMI patients with multivessel disease, preventive PCI in non-infarct arteries substantially decreases the risk of major adverse cardiovascular events.
  • PCI limited to the infarct artery is less effective than a strategy including preventive PCI for non-infarct arteries.
Abstract

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