Bệnh động mạch vành có gì mới trong năm 2015-2016

15th

National Congress of Cardiology

Hanoi, Vietnam, October 9-11, 2016

Coronary Artery Diseases Year in Review
2015-2016
Five Trials That Will Impact Patient Care

Gregory W. Barsness, MD, FACC, FAHA, FSCAI
Consultant, Internal Medicine & Cardiology and Radiology
Director, Mayo Clinic EECP Laboratory
Director, Mayo Clinic Cardiac Intensive Care Unit

Mayo Clinic College of Medicine
Rochester, MN, USA


CAD Trial Year

in Review

Incremental

Impact

of

PCI

ACS

Prevention

DAPT

CULPRIT

HOPE-3

ABSORB II/III

MATRIX

DANAMI-3

Chest Pain Choice

TUXEDO

LEADERS-FREE

RIDDLE-NSTEMI

PEGASUS

IMPROVE-IT

STICH 10-Year

SPRINT

Early BAMI

AVOID

Research

PCSK9

PROCAT II

TOTAL

New

ACCELERATE

COSIRA


CAD Trial Year

in Review

Incremental

Impact

of

PCI

ACS

Prevention

DAPT

CULPRIT

HOPE-3

ABSORB II/III

MATRIX

DANAMI-3

Chest Pain Choice

TUXEDO

LEADERS-FREE

RIDDLE-NSTEMI

PEGASUS

IMPROVE-IT

STICH 10-Year

SPRINT

Early BAMI

AVOID

Research

PCSK9

PROCAT II

TOTAL

New

ACCELERATE

COSIRA


CAD Trial Year

in Review

Incremental

Impact of

Don’t

Maybe

AVOID

CULPRIT

Early BAMI

MATRIX

HOPE-3

ABSORB II/III

COSIRA

LEADERS-FREE

ACCELERATE

STICH 10-Year

SPRINT

PEGASUS

DAPT

IMPROVE-IT

PCSK9

PROCAT II

DANAMI-3

Research

Do

TOTAL

TUXEDO

New

RIDDLE-NSTEMI

Chest Pain Choice


l~I

l~I

~~~~~~~o_n_rr._,_rN_A_1_.A_R_T_1c_,n_.F

~~~~~~~o_n_rr._,_rN_A_1_.A_R_T_1c_,n_.F~~~~~~--'11

Randomized Trial of Primary PCI with or without Routine Manual
Thrombectomy
S.S:.Jal1y;

JA.

~·ms, S. YLl5l.lf; 16. Meeks.

L Th.lb.ii~ G. Stanlu:rwic.,

J.

Pogue, M J. Rc,'kaoss, S. Ki::t:b,

R. Mc.r
K. Niemel~ P.G. Steg. I. Bi:m:a.t, Y.Xu, WJ.C;mlc>r.
JI..N. dieem:i. R.C. W~,n

OF

C.B. Owerg;md.,

ll.!!rtu1n:I.A.Jl.~um.

C.K. N;iber,

It BhindL S. Pan.chol,-.

S.\I. ho. 1.U( N~t~rajan,J.M.ten !Rrg. 0. S~u,

P. Gc30, P. Widimsk,,

;iin:I V. D:h.vlk. for the TOTAL lrr,,utipmrs*

AB:STlll.\CT
CONCLUSIONS

STEMI who were undergoing primary PCI,. routine manual
In patients with ST

throrn•

compared with PCI alone,
did PCI
not alone,
reduce did
the not
riskreduce
of cardiovascular
d with
the ris
bectomy, as compare
myocardial infarction, cardlogenic
death> recurrent my

shock> or

NYHA class IV heart

failure within
within 180
180 da
days but was associated with an
failure

increased

rate of stroke within

Institutes

of Health Research;

30 days. (Funded by

Medtronic and the Canadian Institutes

TOTAL
Clinical'Irials.gov number, NCT01l49044.)
TOTAL Clinical'Irials.
11:CSDLT!i

Th.e: pr'rm31'J' i:tutllDCru!OCCUl'il'«I in .3Q ofsml p3timl! C6..9l,J rn the: ih.rc!llloo:timlJ' group
ih.e ~:ii

'1ll1111-li

351 erseao pati£nl! Cl.Die) in

one ~roup (h..J!zm:I! ntio .in the

dtroimll!lllilCl'J' ~p,

,0.99; 95"'= 00n.6&ce in.~

Ut£5 of C'.l'!ro:iall'lrol 1'11 ~

[C]l, O.fi

IQ 1.

I S; IP'='11,.1! Gl. Toe

(3.r:k With dtrolllOOllWCl'J' 'f'!i. l.S!l: Wjth !=Cl a.llm.Gj.

lh.aa::ml! ratio, 0.'90; ~
a, 0.7.3 1:(1 Ll2; P.cO.l-0 aru:i rh.e piilllill.f 1:tt11mme p]ui
1mn.t dtromClo;5is or illl~msel
r~Jltn:31:ion. ~.9lc "1i. 9.8~ hhml fli!rlllJ l.00; 9!'1'Ar: Cl, o.B9
sicn::ilwr. ~ke:

with.in 30 llaJ5 oc• ourre;t. in .B patil!nt!i (O.n)

in tihe PCfilJDn.e fn:!up flt3z3rll riJ.:i,(], :2-0li, 9'n: G, '1.13

in th.e tlumrllie!:tom:,

11:D

group

l1JJ

1.14; P.:.0.95) 'l'IVE ILlm

'JEfSU~ ff, p.i:til!nt!i {~

3.75; P=>0.02)..

CCIICLV.SJQIU

111. p:!liet.ts wirh. STl!Jilil ~·ho

we-e nnlfergoing [Pfloli!laJf PCI, routine

m.:rn.11a! th.[D(llf• bel:MJC1LT, as c0Illj)i!J8111•ith PC! alon.e,

cl?d not ml:ure lhe risl:- of c:.an'.liCJT.llilltiJ3r d£3fh.,Jmull0lt rnyllC'lldi:il inllllt'Cti!ln,

llriiu rewidi.i;n
Mt

,d.J.fii.

1EO dzjs tlu.t ~'al§ l!.cSS003bell 'l!i'ith an ini:rea5eil

(Pun.d'.ed lly MOO:lfOn.ic 311.cl th.e Onarli:m lnstitutBS of He:ilrh. ~.

TOTAi. a inie.'!.ffi'iaJ~

m moo, Menn U'!I044.J

1:3fdiclg0'Lie' aoor,

rate of c51fDke with.i;n

or N'i}il\

nass

IV healt


Thrombus Aspiration in PPCI
Meta-Analysis of Mortality
Adjunctive device prior

to PCI

PCI

alone

6
5.3
P = 0.018

P = 0.050

4.4
I

Mortality (%)*

4

IIa

IIb

III

3 .4

3. 1
2.8

2.7

2

0

Bavry AA, et al.

Manual thrombus

Mechanical

Embolic

aspiration

thrombectomy

protection

Eur Heart J. 2008

*Weighted Mean

5.0 months


TOTAL Trial Flow and Adherence
10,732 enrolled and randomized

10,066 underwent PCI for STEMI

5033 Manual

5030 PCI Alone

Thrombectomy
Cross-over to
Crossover to PCI
alone

in 230 (4.6%)

5033 included in analysis
TOT
AL

Thrombectomy as inital
strategy in 69 (1.4%)
Bailout Thrombectomy
in 355 (7.1%)
5030 included in analysis


Jolly et al. Lancet 2015

Higuma JACC Card Int 2016;8:2002


Jolly et al. Lancet 2015


2013 ACC/AHA STEMI Guideline
Thrombus Aspiration

in

PPCI

Manual aspiration
I

thrombectomy is reasonable
for patients undergoing PPCI

IIa IIb

III


2015 ACC/AHA STEMI Guideline
Thrombus Aspiration

Routine aspiration

in

PPCI

I

IIa

IIb

III

I

IIa

IIb

III

thrombectomy is not useful
before PPCI

Usefulness of selective and
bailout thrombectomy in
PPCI is not well established


Deferred versus conventional

stent implantation in patients

with ST-segment elevation myocardial lnfarctlon
(DANAMI 3-DEFER.): an open-label, randomised controlled trial
Hmvqlllbd:, Dein El-Hofstt11.l
Lme fb'rrMlll!I EntJ~

frantsl't,fmni

lilri5oow.Jmdi. Ur Ile ll\,d;rr; lillEJiilnglloo.s Fl(q,w.l,J111Wbl«1~KriA.k11111'111;\.1. iif>Vcj.z,;.,~

HomE e.rtcr. Clriot.iarJJTCl'tdK!\

[w ~H0rm""""'IJ'"' llmti1!~ Hon,,,HPot,,-0,,m=

ll'e,r

.s...n:1£ ,.,....,. li
C.-""'*',Jonl Mod'=\ a....ti!lnTO')>l'<,f=<JJ 11>,mw[ ngm,,rn

Sum marry
lla(j.kgJc11mlil Desplli! suc:a,ssful m1atml!Cl1 of the, rulpt11 artl!I)' lestoa "b)· prlmaty Jl'l!IOllaru!Oll'> onunarr 1mer,,l!Cl1Lon

Mw.!C>5no

Afd~.,n6
jPCII
s:taLt lmpl;mt1L1aa.1aromboL1cemballsaL1cm
o,crurswe
tn seme
wh1c:b
ofp.111:ems
w11a with
ST-s:eipnem
ele.·at1on m)11Cll'dlal Lnf.uollon (STEMI).
armedCISeS.
to assess
thermpnrs
dLnl:C1ldu!p:n:ignosts
autCllllles of d.eferred
s:1.e.m

~m.'"!1~0.a:J.6/

1mpla111at.1011ve:m1s seandard PC! la palll!ll:tswl"th STIMI.

511140,•1']6QfiJlJl'!l>l
S..C>6./(a

Metnol!s we dldl dtl5 Ol]el1-bb1!l. :randomtsed

controllc.:l.1111al at lilllll' IJl;!mar,, rc1 Cl!Cllrl!!l tn Di!runJirlc. El~i!,

..... ..,.,...,, o,mm.•

aa1tents

......
~.doi..ag.rt:i.~J.fii'

interpretatjon
interpretatjon In
In ppatients with STEMI, routine deferred stent implantation did not reduce the occurrence of death,
heart failure, myoc

ardial infarction, or repeat revascularisation compared with conventional

PCl Results from

ongoing
d trials
mightlight
shedonfurther

light on
concept
of deferred
in this pa
ongoing randomise
randomised trials might shed
further
the concept
of the
deferred
stenting
in this stenting
pa

tient population.

MQFJI...... MQ

allocauoa. we d.ld :mai}Sls II,· tme:mlon ta 1reat.. l11.Js ulal Is reipste:red wlth Cllnbllnals..go,·.number NCT0143~8c

[-....,;11,1111
DO. La.MD,

Rl!llr:igs

Elelween March 1• znn. and. Feb 28,, 2JH4. we, randcrm.ly assigned UIS patterns ta !Ea!h•e either standard. PO

N.,,...,.,llltT~D,

jn-612) or IL!f!!fl"eclSN!llt Lmplurt1flo11,(n-f.O]). Medi.la followsap ltbru!was 42rnontfu;{IQR 33-41Jj.. li>emsoornpnstng !he

anlllltiiv1rr9ntolC.~

.-....-llmpt,,I

prtmaJ)' endpeuu OCOIJTed lnJ 109 {111%1 pallents who Juel !il3lldard PO a11d In 1.05 ,[17%1 patJl!DtS wllo had dl!f!!fl"ecl Sll!llt

1mplmtailan (IR,ard rarliJ o ·!19. 9'5% Cl o · 76-1· 19; p,-0· 921- l'ro
dKM..i-MQ

lllterpll!taUon ta partems with STEM I, llllllllll!! dl!ferredl 5tem 1m;plama1lon did 11111 reduce: dte ocrurramEof dl!Jih.
1nr.1rn100. or Tl!pl!a\ Tl!l•il!Ollall.Siltlon

~..-~

IYUap-11.1,n.,MD,

111,msfasloo or SUJ:Bl!l)'. c:antrZS1-lllduced aepaop;uby. or StrOlie eccurred In.28 ,(5%) p.wellts In ihe ma-.·ooL1Dral PO ~
,·l!r!,us ll ,(4%) pat1l!Clts In the deferred srl!Cl1 lmpl.1m31100 grmip.wlla no :51R111£icmt mlferencl!5 betwel!D ·groops.

hear1 filh11e.. CTl)·ocardlal

........

!lop-al~

~

Ea.p"•,1,.11.,...;.iy,.

oornpaTl!d wL'111 con,-ea11.0n.Jl !'Cl. IR15alt!; from

A..i..,A.a&..,.o-,,,.,i, CIT.W...l,l;l

l.1"cf'~Efio
on~ag randomtsed u!a.ls might shed fwlhl!,f llgllt on the macepi o! der1!!Tedsiemrng In thts Jmlffit ])lllllllatlan.

FU11!ll11g Da111ShAge:aq, for science, 100mooa~ and lano.·allofl., a.11d DaalS!t Olllm:ll. fol Straiegt.c Research.

LEBm,gMD,

J~MD,KN,-1,E,

EH-Mill<

o.p.-al~
A,11,.,~U.,.....,..,

lnbocluction

blood Row bas bee:a secured la tbe ltlfam-rela.ted

nmel)· pnmaJ)•·pemwmemm CDTOOal}' ln1£r\•entJon (PCI)

:mi!!)·. could preserve coronary blood Sow and radua!

db.loldoMJt~n.,,,,l!IIQ

AB'RimonMQJA-IC\

sl'.md:ml
palll!rm
STasiggm,mt ele,,al!lon1he
baDoon tn?aunl!nt
d:l!atat1aafor:and
seemwttb
nnplanesuon
Is !he

0
antcnme.•pa1e111.tall}'
Deferred sterufag SEJ,,.n.,,1,1),B~D)<
seems
ru:l· of emboltsauon,improee
anddtmcal
thereby

111)-oa:nl!al

:same

with

lnla~

[STEM I]." , Ho:-'er;

In

10

both

redua! tlu"ombus

burden

and

lloop.,_.

,1,,11,.,'!Jl,,o..,,,,..

o.p.-..al~

tncrease

°" " " ·

N

t

m

•E

bp

Primary

PCI

vs.

Fibrinolysis

Meta-analysis of 23 RCTs of 7739

pts

NNT = 50

NNT = 17

4-6

week

outcomes

25
21

PCI

20

Lysis

15

13

%
10

9
7

5

7

6

2.2

8

7
5
1

2
0

1

0
Death

Keeley

and Grines. Lancet 2003

Re-MI

Rec

Total

Hem

Major

Death

Isch

stroke

stroke

bleed

MI Stroke

BMS vs PTCA in AMI
Meta-Analysis

of

13

RCT

(n=6922)

De Luca et al. Int J Card 2007;119:306


Previous Deferred Stenting Studies
Adverse Outcome of Stent in PPCI
Distal embolization occurs in 7% of cases
Slow or no-flow
Study

occurs in 10%
n

Primary endpoint

of cases
Results
_

Non-randomised
Meneveau
Isaaz
Tang
Cafri
Ke
Randomised
Pascal
DEFER-STEMI
MIMI

78

Procedural success*

↑ 18%

93

TIMI 3

↑ 40%

87

TIMI frame count

↓ 22%

106

thrombotic events

↓ 23%

103

MACE

↓ 20%

279
101

MACE-free survival
no-/slow fow

↑ 15%
↓ 23%

140

MVO (% of LVmass)

↑ 111%**

* DS <30%, TIMI 3, no distal embolizaton

**in favor of immediate stentng

Flow Chart DANAMI-3
STEMI

To evaluate whether the prognosis of STEMI patients treated with PPCI
Angiography

can be improved by deferred stent implantation
TIMI 0-I

TIMI 2-3

Randomiza
PCI
Defer: MinimalPCI
manipulation
to restore

TIM
I 0-I

flow with
stent implantation at 48-72 hrs
TIMI 2-3
Conventional: Immediate PCI with stent

Excluded

Postcon

Conv

Defer

tion


0.25

Primary endpoint

Conventional

HR: 0.99 [0.75-1.29];

Deferred

0.10
0.05

Primary Endpoint Composite:
All cause mortality, heart failure
hospitalization, re-MI, and TVR

0.00

Event rate

0.15

0.20

P=0.92

0

1

2

3

Time (years)
Number at risk

Conventional 612
Deferred 603

568
543

533
526

360
359

159
156

0
0

4

5


Components

of the Primary Endpoint
Recurrent myocardial reinfarction

All cause mortality
B

A

0.25

Conventional

Conventional

HR: 0.83

HR: 1.1 [0.69 - 1.64];

Deferred

P=0.77

0.20

[0.56 - 1.24]; P=0.37

0.00

0.20
0.15
0.10
0.00

0.05

Cumulative incidence

0.15
0.05

0.10

Event rate

0.25

Deferred

0

1

Time (years)
3

2

4

0

1

2

5
Conventional 612
Deferred 603

3

4

5

Time (years)
584

594

575

575
409

403
180

0

173

0

Deferred 603

564

Number at risk

550

383

167

0

Number at risk

C

Hospitalisation for heart failure

Conventional 612Unplanned
586
D

379
HR: 0.82 [0.47 - 1.43]; P=0.49

HR: 1.7 [1.04 - 2.92]; P=0.03

0.20
0.15
0.10
0.00

0.05

0.05

0.10

0.15

Cumulative incidence

0.20

0.25

0.25

Deferred

0.00

Cumulative incidence

0

Conventional
revascularisation

Conventional
Deferred

165

554vessel
target

0

1

2

3

4

5

0

1

Time (years)

3

4

5

387

170

0

Time (years)

Number at risk

Conventional 612

2

Number at risk

580

560

391

167

0

Conventional 612

587

561


Components

of the Primary Endpoint
Bottom Line

Routine deferred stenting was associated with
Current practice of PPCI is difficult to improve upon with current technology

an increased rate of target vessel

DEFER is underpowered: minimal signal (LVEF)

revascularisation, mainly due to premature

INNOVATION

and
and PRIMACY
PRIMACY may
may add clarity

stent implantation
Prompt reperf
placeme
Prompt
reperfusion
and (drug-eluting) stent
Unplanned target vessel revascularisation

nt is warranted
in
placement is warranted
in
PPCI
D
5

5

0.0

.
0

0.00

C

u

2

0

1

2

3

Time (years)
Number at risk

C

Conventional 612
0

587

561

387

170

o

Deferred 603

n
v

0

559

549

382

167

4

5


Randomized

Lesion-Only

Trial of Complete Versus
Revascularization

Undergoing

Primary Percutaneous

Coronary

Intervention

and Multivessel
The CvLPRIT

.......

in

Patients

for STEMI

Disease

Trial

Anthony H. Gerablick, MBBS,• Jamal Nasir Kba.n. MB Ot!B,• D.ami.:m l Kelly. ?.ffi oe, MD,t
John P. Greenwood, MB OIB, PKD, t~ 1h.i,agar.ajah

Sasika:ra.n. BSc, PH!D, 11 Nick Curzei, Bl>.{. P:HO .,

Thmiel l lUackman., MD,~ Miles Dalby, MBBS, MD,t KatJ:u:ynL. Fairbmther, BA,0

W:inston Banya, MSc,ft

Duol.ao Wang, PHD .n Ma.n:w Father,MB BS.}~ Simon 1-. Hetherington. MB

oe, MD .JI

II

Andre.YD. Ke.lion, BM BO!., DM,1'1 Sunl!l!l T:a.lwar. MB BS, MD.II Ji.tlrk Guiming, MD.'"' Roger H3Jl, MD.~

CONCLUSIONS

Swanton.
MB. BO!!R, MD.
ttt Ge.n:ywith
P. McCa.nn.
MB C!!.B,
MD•
InHowa.ni
patients.
p11esenting
for P-PCI
multivessel
disease,
index admission complete re,as

cularization signif•

icantly lowered the

rate
monthscomparedwithtreatingonlythe
I
rateofofthecornposlte
thecornposlte primary endpoint.at12
primary endpoint.at12
monthscomparedwithtreatingonlythe

IRA. In such patients,

inpatient
inpatient total
total rev
revascularization may be considered, but Larger dl nical tria Ls are irequi IBd to confirm th is res u
address whether thi
[CvLPRll];
[CvLPRll];

lt and s pedfically ology

ss strata
strata gy
gy is
is associated
associated with

with imp
imp roved
roved survival.
survival. (( Conn
Conn plete
plete Versus
Versus Les
Les ion-only
ion-only Primary
Primary PCI Pi Lot S.tu:cly

IS.RCTN709B60 5) (J Am Coll Cardiol 2015;65:963,-72) © 2015 by the American College of Cardi
MnMCIDW Afm1h!yplOIM!d-'m.ZW!llt

unl!nN!ntmmnaryangloglaplly2, gf! padffl1s

ranloomlzed throu,gh an orte;-act:M! volce-leSpOOiS!! program to elthe1111-lla;ptal

7U.IC.

t'Mtt!l5wtrl!

am p'ete re,,,.aiO!JlaJtz.a tlon (n - 150) or

IRA-orty revasaJlariz.atm (n - 14'6). Ccmj:l.ete revas.artariz.atm was peifooned either at the time of P·PCI or bef«e
~Jtald6dwge,. R.andomiz.aboo wa. stratified by 111.t:am loc.atim (Mtenor/oonantel'lOf) and :l)'mptool OIISl!!t {:£3 h
o,

=-3 hJ. The pnl!Ul''.Ji ~t w:as a COfT\l)051lte d all-cau.se ~a1h. reaurm.tmyocardial ,nf:arction (Mii). heart f~

.

.and ls.dlemi.a-driven revas.rularlz.atlon wrthjn 12 mooths.

IR.E.SULTS Patient g-wpswe1ewEilmatdiedfor~clLnk.ald!Mactensth lhe pnmary !!!fld;pwttocauredin10.0%
of the COlff\P'l!!te revas.oularlz.auoogroup ~=,s, 21.2%

in

the I RA-oo.fy re...asculanzaoon ~

{hazaid ratio, 0.45.: 95%

coo.fidence llter.at,0.24 to 0.84: p - 0.009). A trend wward bene1it was seen e.3!ly afte, complete re...ascuh1faatioo

(p- 0.055 at 30 days).Althooghthere was nos4gn.tfic.ant redtctm Indeathor Ml. a n.cns.,gnJfic.at redoctkn

endpo,.flt COfllj)Of1elt:s. was

,n

all;inmary

:s,een. lhere 'Illas no redue1iloo kl isdlemk burden oo ll"l)OCardatpe.rfu;SMlfl s.an1lgralfly

s.afet)' ~ts d fn¥W bl.eedng, cut1ast-illl!dtud nephropathy, or strob! between th! group;.

co NOLus IO:NS Inpatientspl!S!!!lltllgf« P-PCI v.th multM!~dl>!!a;e.adel: aitru.slon IDl!lpleterevas.aJarizat bn Sl!ll(lf.
bntl)'bwere:lthe rate of the ~pnmaiyel1od,poont atl2 mm.1ru.mmpared'llll1h tu..t,ngonl)'1fle IRA. lngidlpat.!!llts,
lnpSt

ent

tat.alre,,;;isauizatlm may be mmklere:I. but larger dinlcat mats.are reqwedto cmfinn thJsregilt and~

address""'1Elher tlti suateg), .s ~tedwlth mi:ro-t su-,,i.,at (Complete Verst5 Les.lm-mfyPnrnaJ)' PCI Alo: :Study
[Cvu~

rtJ:

ISRCTN,0913605)

(J Am~

ardol.2CHSi6S,91i3-72j

11:l :.,0151\, the Ama'ic;,n Cdlegeof'Qrdld.ogy

FOJflidltloo..

a 111th-e

Foundatim1.


Primary

PCI

Angiogram

IRA
MVD in 30 - 60% of STEMI Higher mortality than single vessel
Culprit lesion PCI improves outcome
Is immediate non-culprit artery PCI indicated?
• Recent ACC/AHA guideline class III

• “Permitted” if shock
• Previously performed in up to 10-15%
• Identifying appropriate Non-IRA targets difficult


STEMI with MVD

>70% single view / >50% two views
YES

Stratified Anterior/ non-anterior Sxs

Randomized (during IRA PCI)

<3hours/>3hours

150 complete (index hospitalization)

146 IRA Only

Treatment received:

Treatment

received :
139 IRA only

139 Complete revascularization (64% ad hoc)

7 complete revascularizaton
CMR Substudy

3±2d

8 IRA only

CONSENT

3 IRA only and referralCMR
forSubstudy
CABG
3±2d

N=105

N=98

MPS 6±2 weeks

MPS 6±2 weeks

N=101

N=104

CMR 9-12

CMR 9-12

months

months
Of 146 ITT Loss to followup n=8

Of 150 ITT
L

oss to follow-up
n=11

6 No consent

2 withdrew

8
No consent
2 withdrew
1 no contact

MACE at 12 months

MACE at 12 months

138 included in intention to treat

139 included in intention to treat

analysis

analysis


The 12-Month Primary Endpoint Composite

Total mortality, re-MI, CHF, ischemia-driven

revascularization

Gershlick, et al. J Am Coll Cardiol. 2015;65:963-972


CvLPRIT

Conclusions
55% MACE reduction with PPCI + Non-IRA lesion(s)
on index admission with no adverse safety signal
compared with IRA-alone

Hard events (death, MI, HF) reduced
magnitude

as

repeat

(5 vs 13%) to same
revascularisation

(4.7%

vs

8.2%)

Does not answer primary question of appropriate timing or identification of suitable lesions for
staged PCI

Gershlick, et al. J Am Coll Cardiol. 2015;65:963-972


Meta-Analysis of Recent Trials of
Complete Revascularization in STEMI
Complete vs Culprit-Only Revascularization