Navigation Links
Preventive PCI results in better outcomes than culprit artery PCI alone in ST elevation MI
Date:9/1/2013

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
press@escardio.org
44-773-005-7146
European Society of Cardiology
Source:Eurekalert

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:
*Name:
*Comment:
*Email:
(Date:10/12/2017)... (PRWEB) , ... October 12, 2017 , ... Planet Fitness, ... the U.S., announced today its plans to open a flagship location in Covington, LA ... the former Rooms To Go store next to Office Depot in the Holiday Square ...
(Date:10/12/2017)... ... October 12, 2017 , ... The American College of Medical Informatics (ACMI) will ... during the Opening Session of AMIA’s Annual Symposium in Washington, D.C. AMIA’s Annual ... F. Collen, a pioneer in the field of medical informatics, this prestigious award is ...
(Date:10/12/2017)... ... October 12, 2017 , ... Dr. Parsa Mohebi, the Los ... article to the newly revamped Cosmetic Town journal section, featuring articles ... procedure known as Follicular Unit Extraction (FUE). , Dr. Mohebi says ...
(Date:10/12/2017)... ... October 12, 2017 , ... On Saturday, October 21, the ... – Miles by Moonlight to raise money for the American Heart Association Heart Walk. ... , Teams will work together to keep their treadmills moving for 5 hours. Treadmills ...
(Date:10/12/2017)... ... October 12, 2017 , ... In the United ... year. In some states—like New York, New Jersey, Massachusetts, Texas, Virginia, Connecticut, and ... havens have extremely low property-tax rates, which contributes to the relatively lower cost ...
Breaking Medicine News(10 mins):
(Date:10/11/2017)... FRISCO, Texas , Oct. 11, 2017 /PRNewswire/ ... healthcare services, has amplified its effort during National ... patients about hereditary cancer risks. ... Journal of Clinical Oncology calculated that more than ... to have inherited mutations in BRCA1 or BRCA2 and ...
(Date:10/5/2017)...  In response to the nationwide opioid epidemic, ... (AAOMS) released prescribing recommendations that urge ibuprofen – ... a first-line therapy to manage a patient,s acute ... Recognizing the value and importance of the ... Acute and Postoperative Pain Management" stresses that practitioners ...
(Date:10/2/2017)... 2017  Eli Lilly and Company (NYSE: ... third quarter of 2017 on Tuesday, October 24, 2017. ... day with the investment community and media to further ... call will begin at 9 a.m. Eastern time. Investors, ... webcast of the conference call through a link that ...
Breaking Medicine Technology: