Original Investigation
Long-Term Follow-Up of Complete Versus Lesion-Only Revascularization in STEMI and Multivessel Disease: The CvLPRIT Trial

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Abstract

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)

Key Words

complete revascularization
multivessel disease
myocardial infarction
noninfarct-related lesion
primary percutaneous coronary intervention
ST-elevation

Abbreviations and Acronyms

CR
complete revascularization
FFR
fractional flow reserve
IDR
ischemia-driven revascularization
IRA
infarct-related artery
MACE
major adverse cardiovascular event
N-IRA
noninfarct-related artery
PCI
percutaneous coronary intervention
P-PCI
primary percutaneous coronary intervention
STEMI
ST-segment elevation myocardial infarction
TLF
target lesion failure
TVR
target-vessel revascularization

Cited by (0)

The CvLPRIT trial was funded by the British Heart Foundation (SP/10/001) with support from the National Institute for Health Research (NIHR) Comprehensive Local Research Networks, in particular, by the NIHR infrastructure at Leicester Leeds. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR, or the Department of Health. The authors have reported that they have no relationships relevant to the contents of this paper to disclose.

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