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Infarct size and left ventricular remodelling after preventive percutaneous coronary intervention

Lookup NU author(s): Dr Rajiv Das, Dr Richard Edwards

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Abstract

Objective We hypothesised that, compared with culprit-only primary percutaneous coronary intervention (PCI), additional preventive PCI in selected patients with ST-elevation myocardial infarction with multivessel disease would not be associated with iatrogenic myocardial infarction, and would be associated with reductions in left ventricular (LV) volumes in the longer term.Methods In the preventive angioplasty in myocardial infarction trial (PRAMI; ISRCTN73028481), cardiac magnetic resonance (CMR) was prespecified in two centres and performed (median, IQR) 3 (1, 5) and 209 (189, 957) days after primary PCI.Results From 219 enrolled patients in two sites, 84% underwent CMR. 42 (50%) were randomised to culpritartery-only PCI and 42 (50%) were randomised to preventive PCI. Follow-up CMR scans were available in 72 (86%) patients. There were two (4.8%) cases of procedure-related myocardial infarction in the preventive PCI group. The culprit-artery-only group had a higher proportion of anterior myocardial infarctions (MIs) (55% vs 24%). Infarct sizes (% LV mass) at baseline and follow-up were similar. At follow-up, there was no difference in LV ejection fraction (%, median (IQR), (culprit-artery-only PCI vs preventive PCI) 51.7 (42.9, 60.2) vs 54.4 (49.3, 62.8), p=0.23), LV end-diastolic volume (mL/m(2), 69.3 (59.4, 79.9) vs 66.1 (54.7, 73.7), p=0.48) and LV end-systolic volume (mL/m(2), 31.8 (24.4, 43.0) vs 30.7 (23.0, 36.3), p=0.20). Non-culprit angiographic lesions had low-risk Syntax scores and 47% had non-complex characteristics.Conclusions Compared with culprit-only PCI, non-infarct-artery MI in the preventive PCI strategy was uncommon and LV volumes and ejection fraction were similar.


Publication metadata

Author(s): Mangion K, Carrick D, Hennigan BW, Payne AR, McClure J, Mason M, Das R, Wilson R, Edwards RJ, Petrie MC, McEntegart M, Eteiba H, Oldroyd KG, Berry C

Publication type: Article

Publication status: Published

Journal: Heart

Year: 2016

Volume: 102

Issue: 24

Pages: 1980-1987

Print publication date: 01/12/2016

Online publication date: 08/08/2016

Acceptance date: 22/06/2016

ISSN (print): 1355-6037

ISSN (electronic): 1468-201X

Publisher: BMJ Publishing Group

URL: http://dx.doi.org/10.1136/heartjnl-2015-308660

DOI: 10.1136/heartjnl-2015-308660


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