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Long-Term Follow-Up of Complete Versus Lesion-Only Revascularization in STEMI and Multivessel Disease: The CvLPRIT
Anthony H Gershlick1, Amerjeet S Banning1, Emma Parker1
1Department of Cardiovascular Sciences, University of Leicester and Cardiovascular Theme, NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, United Kingdom.
Insights
Complete revascularization in ST-segment elevation myocardial infarction patients significantly lowers major adverse cardiovascular events long-term. These benefits, including reduced death and MI, are sustained over a median of 5.6 years.
Area of Science:
- Cardiology
- Interventional Cardiology
- Clinical Trials
Background:
- Randomized trials indicate complete revascularization reduces major adverse cardiovascular events (MACE) in ST-segment elevation myocardial infarction (MI) with multivessel disease.
- MACE encompasses all-cause death, MI, ischemia-driven revascularization, and heart failure.
Purpose of the Study:
- To evaluate the long-term sustainability of complete revascularization benefits in STEMI patients.
- To assess the impact of complete revascularization on hard clinical endpoints over an extended follow-up period.
Main Methods:
- The Complete versus Lesion-only Primary PCI Trial (CvLPRIT) was a randomized trial comparing complete revascularization versus infarct-related artery-only revascularization.
- Patients were followed long-term, with data collected from patient records and databases.
- Median follow-up was 5.6 years.
Main Results:
- The primary MACE endpoint rate was significantly lower in the complete revascularization group (24.0%) compared to the infarct-related artery-only group (37.7%) (HR: 0.57; p=0.0079).
- The composite endpoint of all-cause death/MI was also significantly lower in the complete revascularization group (10.0% vs 18.5%; HR: 0.47; p=0.0175).
- Landmark analysis from 12 months to final follow-up showed no significant difference in MACE or death/MI between groups.
Conclusions:
- Long-term follow-up of the CvLPRIT trial confirms sustained lower rates of MACE in patients undergoing complete revascularization.
- Complete revascularization demonstrates a significant long-term benefit in reducing the composite endpoint of all-cause death/MI.
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).
