Complete Versus Lesion-Only Primary PCI: The Randomized Cardiovascular MR CvLPRIT Substudy

Area of Science:

• Cardiology
• Interventional Cardiology
• Cardiovascular Imaging

Background:

• Complete revascularization may improve outcomes in STEMI patients with multivessel disease undergoing primary PCI.
• Concerns exist regarding potential non-infarct-related artery (non-IRA) myocardial infarction (MI) with complete revascularization strategies.

Purpose of the Study:

• To determine if in-hospital complete revascularization increases total infarct size compared to an infarct-related artery (IRA)-only strategy in STEMI patients.
• To assess the incidence of non-IRA MI following complete revascularization.

Main Methods:

• A multicenter, prospective, randomized, open-label, blinded endpoint trial.
• STEMI patients with multivessel disease received either IRA-only PCI or complete in-hospital revascularization.
• Contrast-enhanced cardiovascular magnetic resonance (CMR) assessed infarct size pre-discharge and at 9 months.

Main Results:

• Total infarct size was similar between the IRA-only (13.5%) and complete revascularization (12.6%) groups (p=0.57).
• A statistically significant increase in non-IRA MI was observed in the complete revascularization group (22/98) compared to the IRA-only group (11/105) (p=0.02).
• No significant difference in total infarct size or ischemic burden was found at 9-month follow-up CMR.

Conclusions:

• Complete revascularization in STEMI patients with multivessel disease does not significantly increase total infarct size compared to an IRA-only strategy.
• A small increase in CMR-detected non-IRA MI is associated with complete revascularization.
• The findings suggest a trade-off between potential benefits and risks of complete revascularization in this patient population.