Long term benefits of complete vs infarct-related artery revascularisation

Takeaway

• In patients with ST-segment elevation myocardial infarction (STEMI) and multivessel coronary disease, complete revascularisation (CR) is associated with reduced rates of major adverse cardiovascular events (MACEs), including myocardial infarction (MI) and death, during long-term follow-up, than revascularisation of the infarct-related artery (IRA) alone.

Why this matters

• Findings support the longer-term safety and efficacy of CR in patients with multivessel STEMI.

Study design

• Long-term follow-up of CvLPRIT study included 272 patients with STEMI and multivessel disease who were randomly assigned to receive CR (n=138) and IRA revascularisation (n=134).
• Primary outcome: rate of MACEs.
• Secondary outcomes: risk for composite of all-cause mortality and MI and the individual components of MACEs.
• Funding: the British Heart Foundation.

Key results

• In the intention-to-treat analysis (randomisation to long-term follow-up):
  • During a median follow-up of 5.6 years, CR vs IRA group had lower:
    • rate of MACEs (HR, 0.57; 95% CI, 0.37-0.87; P=.0079) and
    • risk for the composite of all-cause mortality and MI (HR, 0.47; 95% CI, 0.25-0.89; P=.0175).
  • No significant difference was observed between CR and IRA group in:
    • all-cause mortality (HR, 0.51; 95% CI, 0.22-1.16; P=.1001),
    • MI (HR, 0.43; 95% CI, 0.16-1.15; P=.0837),
    • HF (HR, 0.42; 95% CI, 0.13-1.37; P=.1383) and
    • IDR (HR, 0.76; 95% CI, 0.40-1.49; P=.4447).
• In a landmark analysis (from 12 months to final follow-up):
  • no significant difference was between CR and IRA group in:
    • MACE (HR, 0.71; 95% CI, 0.40-1.27; P=.248),
    • all-cause mortality (HR, 0.63; 95% CI, 0.23-1.68; P=.3478),
    • MI (HR, 0.41; 95% CI, 0.12-1.36; P=.1333),
    • IDR (HR, 1.12; 95% CI, 0.44-3.04; P=.7694) and
    • death/MI (HR, 0.53; 95% CI, 0.25-1.12; P=.0905).

Limitations

• Small sample size.