Preventive Angioplasty, Stenting Decrease Risk of Cardiac-Related Events After MI: Presented at ESC

By Alex Morrisson

AMSTERDAM, the Netherlands -- September 5, 2013 -- Patients being treated for a myocardial infarction (MI) who have the culprit lesions treated with percutaneous coronary intervention (PCI), as well as other large stenosis in other arteries treated as well, reduce their risk of cardiac death, MI, or unstable angina episodes compared with patients who just have the MI-related lesion treated.

During a mean follow-up of 23 months, researchers observed a 65% reduction in cardiac-related events if patients underwent interventions beyond the culprit lesion [hazard ratio [HR], 0.35; P < .001).

The findings, presented on September 1 at the 2013 Annual Meeting of the European Society of Cardiology (ESC) and published simultaneously online in the New England Journal of Medicine, found that the primary endpoint of cardiac death, non-fatal MI or refractory angina was experienced by 21 of the 234 patients receiving preventive angioplasty compared with 53 of the 231 patients who only had their culprit lesion treated.

“When we looked at just cardiac death and non-fatal MI -- the 2 most severe events in the composite -- the results were similar,” said David Wald, MD, Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine, London, United Kingdom.

Overall, 11 patients who underwent the preventive angioplasty strategy experienced cardiac death or non-fatal MI compared with 27 events among patients not receiving the more extensive therapy (HR, 0.36; P = .004).

Four of the deaths in the extensively treated group were due to cardiac death and 7 non-fatal MIs were observed. Among those not treated, 10 died from cardiac reasons and 20 had non-fatal MIs.

“In patients with ST-segment elevated MI and multi-vessel coronary artery disease undergoing infarct-artery PCI, preventive PCI in non-infarct coronary arteries with major stenosis significantly reduced the risk of adverse cardiovascular events as compared with percutaneous coronary intervention limited to the infarct artery,” said Dr. Wald.

The Preventive Angioplasty in Acute Myocardial Infarction (PRAMI) study enrolled patients after they had undergone successful PCI of the infarct-related lesion and doctors observed lesions of ≥50% in 1 or more coronary artery other than the infarct artery, and that stenosis were deemed treatable by angioplasty procedures.

Dr. Wald said the goal was to randomise 600 patients, but the Data and Safety Monitoring Board (DSMB) -- noting the favourable results of the trial -- recommended the trial be halted after 465 patients had been treated.

A median of 1.5 stents were implanted in the artery where the culprit lesion was located; a median of 1.4 stents were implanted in other arteries.

[Presentation title: Randomized Trial of Preventive Angioplasty in Myocardial Infarction. Abstract 1684]

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