Navigation Links
Preventive PCI results in better outcomes than culprit artery PCI alone in ST elevation MI

AMSTERDAM, The Netherlands Heart attack patients with ST elevation who undergo a preventive procedure to unblock additional coronary arteries have significantly better outcomes than those whose treatment is confined to the culprit blockage only, according to the results of the Preventive Angioplasty in Myocardial Infarction (PRAMI) Trial.

The findings, presented today at the ESC and published simultaneously in the New England Journal of Medicine, provide information that will help guide clinical practice and resolve uncertainty over how to approach percutaneous coronary intervention (PCI) for ST elevation myocardial infarction (MI).

"When a patient is admitted with an acute myocardial infarction, it is known that PCI to the blocked culprit artery is life-saving, but there is uncertainty as to whether doctors should undertake preventive PCI in vessels that are partially blocked but did not cause the myocardial infarction. This is a common clinical dilemma," said the study's lead investigator David Wald, MD, from the Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine, Queen Mary University of London and the London Chest Hospital.

The PRAMI trial was stopped early by the Data Monitoring Committee when a planned interim analysis showed a clear benefit in favor of preventive PCI that was evident within 6 months of the procedure and maintained thereafter.

"The results of this trial show that in this situation preventive PCI, in this situation, reduces the risk of cardiac death, a subsequent myocardial infarction or angina resistant to medical therapy, by about two-thirds."

With this new evidence, "consideration can be given to revising current guidelines," he added.

Current guidelines recommend culprit-only PCI for patients with ST elevation myocardial infarction and multivessel disease, because until now there was a lack of evidence in favor of preventive PCI.

In the trial, patients undergoing emergency PCI for acute ST elevation (462) or left bundle branch block (3) myocardial infarction and multivessel coronary artery disease were randomized while in the catheterization laboratory to either preventive PCI (234), or culprit-only PCI (231).

Patients were eligible for the preventive procedure if their culprit artery had been treated successfully and they had a blockage (stenosis) of 50% or more that was treatable by PCI in another or several other coronary arteries.

After a mean follow-up of 23 months (67% of patients had at least one year, and 46% at least 2 years, of follow-up) a total of 21 patients in the preventive PCI group and 53 in the culprit-only group had experienced a primary outcome event (cardiac death, nonfatal myocardial infarction or refractory angina) showing an absolute risk reduction of 14 per hundred patients in the preventive PCI group [hazard ratio 0.35 (95% CI 0.21-0.58), p<0.001], and a relative risk reduction of 65%.

The rate of complications was similar in the preventive and culprit-only PCI groups (procedure related stroke 2 vs 0; bleeding requiring transfusion or surgery, 7 vs 6; and contrast-induced nephropathy requiring dialysis, 1 vs 3).

Procedure time, fluoroscopy dose and contrast volume were increased in the preventive PCI group (median 63 vs 45 minutes, median 90.1 vs 71.4 Gycm2, and median 300 vs 200 mL).

"The results show that on average, preventive PCI extends the procedure time by about 20 minutes, uses an extra 100mls of contrast (the dye used in angiography) and exposes the patient to an X-ray dose equivalent to an angiogram," said Dr. Wald, adding that" the initial costs of preventive PCI are higher but there will be reduced costs thereafter, with a reduced need for subsequent hospital admissions, cardiac investigations and revascularisation procedures."


Contact: ESC Press Office
European Society of Cardiology

Related medicine news :

1. Senior Moments a Prelude to Alzheimer’s: Not Necessarily - Your Physician Can Enable Evidenced Based Preventive Steps With OTC Supplements
2. Rob Tazioli Named U.S. Preventive Medicine CEO
3. Study finds boys more likely to receive HPV vaccine when their mothers receive preventive care
4. Medicaid programs vary in coverage of preventive care, report says
5. Genetic variations may help identify best candidates for preventive breast cancer drugs
6. Californians with medical home more likely to get flu shots, preventive treatment
7. Angelina Jolie Has Preventive Double Mastectomy
8. Is your migraine preventive treatment balanced between drugs benefits and harms?
9. Millions Got Free Preventive Care Due to Health Law, HHS Says
10. Many Allergic to Fire Ants Sting Dont Get Preventive Shots
11. The American College of Preventive Medicine Heads to Phoenix to host Annual Meeting
Post Your Comments:
(Date:11/25/2015)... ... ... “While riding the bus, I saw a passenger in a wheelchair drenched from ... a convenient and comfortable way to protect them from bad weather, so I invented ... during cold or inclement weather. In doing so, it ensures that the user remains ...
(Date:11/25/2015)... , ... November 25, 2015 , ... ... (PHA) announces the nation’s Periwinkle Pioneers, individuals and groups responsible for advancing care ... disease. The Periwinkle Pioneers, nominated by the public, will receive special recognition throughout ...
(Date:11/25/2015)... ... November 25, 2015 , ... An unlikely combination ... in a way for homeless people to have a more dignified and comfortable ... initiative whereby they are repurposing plastic bags into sleeping mats for the homeless. ...
(Date:11/25/2015)... ... November 25, 2015 , ... ... focused on providing comprehensive solutions involving adult stem cell therapies to patients with ... deemed the “Regenestem” name as a Registered Trademark (RTM). , Organizations are required ...
(Date:11/24/2015)... ... 2015 , ... Genesis Chiropractic Software helps practice owners automate ... between the practice owner and the patient that automatically manages all five aspects ... Click here to learn more. , According to Dr. Brian ...
Breaking Medicine News(10 mins):
(Date:11/25/2015)... , November 25, 2015 Kitov ... ) (TASE: KTOV), a biopharmaceutical company focused on the ... various clinical conditions, today announced the closing of its ... Shares ( ADSs ), each representing 20 ordinary shares ... 3,158,900 ADSs. The ADSs and warrants were issued in ...
(Date:11/25/2015)... , Nov. 25, 2015 Allergan ... pharmaceutical company, and Rugen Therapeutics, a start-up  biotechnology ... for unmet CNS disorders and funded by the ... they have entered into an exclusive collaboration to ... for Autism Spectrum Disorders (ASD) and Obsessive Compulsive ...
(Date:11/25/2015)... Israel , November 25, 2015 ... "New Investors"), pursuant to which BioLight and the New ... IOPtima Ltd. subsidiary ("IOPtima") via a private placement. The ... of its innovative IOPtimate™ system used in the treatment ... approval pathway process for the IOPtimate™ system with the ...
Breaking Medicine Technology: