Journal Ku

7/24/2019 Journal Ku

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Randomized Trial of Preventive Angioplastyin Myocardial Infarction


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Background

In acute ST-segment elevation myocardialinfarction (STEMI) t!e use of percutaneouscoronary intervention (P"I) to treat t!e artery

responsi#le for t!e infarct (infarct or culpritartery) improves prognosis$ T!e value of P"I innoninfarct coronary arteries %it! ma&orstenoses (preventive P"I) is un'no%n$


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Met!ods

e enrolled *+ patients %it! acuteSTEMI (including , patients %it! left#undle-#ranc! #loc') %!o %ere

undergoing infarct-artery P"I andrandomly assigned t!em to eit!erpreventive P"I (, patients) or nopreventive P"I (,. patients)


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T!e trial enrolled consecutive patients

of any age %it! acute STEMI andmultivessel coronary disease detectedat t!e time of emergency P"I$ T!e trial%as limited to patients %it! STEMI

(including t!ree patients %it! left#undle-#ranc! #loc') #ecause unli'epatients %it! non-STEMI suc! patientsusually !ave a clearly identi/a#le

infarct artery (often occluded) t!at iseasily distinguis!ed from noninfarctcoronary arteries$


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After t!e completion of P"I in t!einfarct artery eligi#le patients %ere

randomly assigned to undergo nofurt!er P"I procedures or toundergo immediate preventive P"I

in noninfarct arteries %it! moret!an +01 stenoses (preventiveP"I)$ T!e randomization sc!edule%as computer-generated in #loc'sof four at eac! study center$


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Results

T!e data andsafety monitoringcommittee t!at%as #ased on a

!ig!ly signi/cant#et%een-groupdi2erence(P30$00.) in t!e

incidence of t!eprimary outcomefavoring preventiveP"I$

4rom April 005t!roug! 6anuary0., a total of*+ patients

%ere enrolled int!e study %it!, assigned tot!e preventive-

P"I group and,. to t!e groupreceiving no

preventive P"I


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T!e results %ere not materiallya2ected #y t!e /ve prespeci/edcovariates 7 age se8 t!e

presence or a#sence of dia#etesinfarct location

and t!e num#er of coronary

arteries %it! stenosis


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9iscussionT!e results of t!is trial s!o% t!at in patients

%it! acute STEMI t!e use of preventive P"I totreat noninfarct coronary-artery stenosesimmediately after P"I in t!e infarct arteryconferred a su#stantial advantage over notperforming t!is additional procedure

T!ese /ndings suggest t!at preventive P"Imay lead to less isc!emia testing and t!at%!en suc! testing is performed it tends to #ein patients %it! symptoms$


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"onclusion

In patients %it! STEMI and multivesselcoronary artery disease undergoinginfarctartery P"I preventive P"I in noninfarctcoronary arteries %it! ma&or stenoses

signi/cantly reduced t!e ris' of adversecardiovascular events as compared %it! P"Ilimited to t!e infarct artery$

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