乌鸦传媒

BARCELONA -- Moving beyond the lesion that triggers a myocardial infarction (MI) to revascularize other occluded, but nonculprit arteries reduced the risk of subsequent heart attacks and mortality, researchers reported here.

In the CvLPRIT trial, the risk of death, recurrent MI, heart failure, or ischemia-driven revascularization at 30 days was 10% among patients who had multivessel revascularization during an initial hospitalization for heart attack versus 21% among patients who underwent stenting of just the target lesion, said , from University Hospitals of Leicester NHS Trust, Glenfield Hospital, in Leicester, England.

Gershlick reported the findings during a Hot Line session at the European Society of Cardiology meeting.

, of Brigham and Women's Hospital and Harvard Medical School in Boston, told 乌鸦传媒 that the findings were particularly interesting in light of the fact that data from "registry studies would suggest quite the opposite: that one should treat the target vessel and not fiddle with others. So I wonder, what was it that enabled these results to be so different?"

Antman, who is president of the American Heart Association, chaired an ESC press conference where the results were reported.

That difference in results was apparent early: at 30 days, 31 of the 146 patients randomized to revascularization of just the target vessel had reached the primary endpoint versus just 15 of the 150 patients who had primary multivessel percutaneous coronary intervention (PCI), a 55% reduction in relative risk (P<0.009). The benefit was durable at 12 months.

Addressing cardiologists in the audience, Gershlick noted the early separation of curves and said "you might want to think about that when you send your patients home saying you will schedule a future procedure for the other vessels."

The study recruited patients who were scheduled for primary PCI for confirmed or suspected MI, with no history of prior coronary artery bypass surgery. All patients had an infarct-related artery plus at least one non-infarct related artery deemed significantly occluded by angiography (more than 70% diameter stenosed in one plane or 50% stenosed in two planes).

Gershlick told 乌鸦传媒 that 57% of the patients underwent multivessel revascularization at the time of the primary PCI, but "in all cases, the revascularization of nontarget vessels was done during the initial hospitalization.

Current ESC and have primary multivessel revascularization listed as a level III recommendation, meaning that to do so is likely to harm the patient.

Gershlick said he thought the findings from CvLPRIT could form the basis for a "discussion" among members of guidelines committees.

ESC spokesperson , head of the Cardiovascular Research Centre, at Aarhus University in Skejby, Denmark, agreed that the CvLPRIT findings were interesting, and he said they did suggest "that we should treat what we see." But he added that guideline committees often take years to weigh such evidence so he predicted that it would be at least 2 years before any formal update could be expected.

, of the Institute of Cardiology at the Pitié-Salpêtrière hospital group in Paris, said that at his center, he and his colleagues "already considered for the last decade that such high-risk patients could not be adequately treated with optimal medical therapy and staged revascularization when it is planned for a month after the primary PCI."

The take-home, Silvain added, was that the "results won't change our practice, but they definitely provide strong data to support such strategy."

of Henry Ford Hospital in Detroit, said it was premature to make clinical decisions based on the CvLPRIT trial, especially since it was "a small study and it took 7 years to recruit -- that is a long time and it does raise questions about patient selection."

But , director of the Harrington Heart & Vascular Institute at University Hospitals Case Medical Center in Cleveland, said CvLPRIT delivered a clear message, "Strive for complete revascularization to optimize outcomes for your STEMI patients."

Simon, who responded to an email query from 乌鸦传媒, said the trial did help clarify cardiologists' questions about timing of complete revascularization. "The results of the trial support at time of [primary] PCI or prior to discharge. This is the current practice of many interventional cardiologists, but we need to wait for further subgroup analysis to determine if revascularization at the time of [primary] PCI is safe," he wrote.

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