non-IRA Lesions Research Articles

Left ventricular outcomes following multivessel PCI vs. infarct artery-only PCI in patients with acute STEMI: the Glasgow PRAMI CMR sub-study

Background In the Randomised Trial of Preventive Angioplasty in Myocardial Infarction (PRAMI; ISRCTN73028481), compared with infarct-related artery (IRA)-only PCI, additional immediate multivessel PCI (MV-PCI) of non-IRA lesions in patients with acute ST elevation myocardial infarction (STEMI) and multivessel coronary disease (MVD) improved long term prognosis. We studied left ventricular (LV) outcomes in a pre-specified cardiac magnetic resonance (CMR) sub-study. Methods In a single centre prospective sub-study, PRAMI participants were invited to undergo CMR at 1.5 Tesla 1 week and 1 year after primary PCI. LV volumes and function were analysed using semi-automated software by a clinician blinded to treatment group assignment and clinical outcomes. The statistical analyses were performed by an independent statistician. Results Of 465 randomised trial participants in 6 UK hospitals, 138 (30%) were enrolled in Glasgow. Eighty patients (17%) (mean age 60 years, 76% male) underwent CMR initially (n = 41 (51%) in the multi-vessel PCI group; n = 39 (49%) in the IRA-only group). 69 (86%) of these patients had a follow up CMR scan at 1 year (n = 7 lost to follow-up, n = 4 deceased). Mean (and SD) LVEF and volumes at 1 week post-MI and their change at 1 year from baseline were similar (Table 1). Conclusion The CMR sub-study participants represented the majority of all randomised participants in our hospital, which included one third of the PRAMI trial population. Random treatment group assignment in this CMR study was evenly balanced. LV function and volumes were similar at 1 week and 1 year post-intervention in survivors. The CMR sub-study suggests that the benefit of the preventive PCI strategy in PRAMI may not be mediated by any effects on LV function and remodelling. Funding Golden Jubilee National Hospital; PRAMI was funded by Barts and the London Charity.

Non-culprit lesion percutaneous coronary intervention during acute myocardial infarction - the road not taken?

ENWEndNote BIBJabRef, Mendeley RISPapers, Reference Manager, RefWorks, Zotero AMA Witberg G, Kornowski R. Editorial commentNon-culprit lesion percutaneous coronary intervention during acute myocardial infarction – the road not taken?. Advances in Interventional Cardiology/Postępy w Kardiologii Interwencyjnej. 2015;11(2):71-73. doi:10.5114/pwki.2015.52277. APA Witberg, G., & Kornowski, R. (2015). Editorial commentNon-culprit lesion percutaneous coronary intervention during acute myocardial infarction – the road not taken?. Advances in Interventional Cardiology/Postępy w Kardiologii Interwencyjnej, 11(2), 71-73. https://doi.org/10.5114/pwki.2015.52277 Chicago Witberg, Guy, and Ran Kornowski. 2015. "Editorial commentNon-culprit lesion percutaneous coronary intervention during acute myocardial infarction – the road not taken?". Advances in Interventional Cardiology/Postępy w Kardiologii Interwencyjnej 11 (2): 71-73. doi:10.5114/pwki.2015.52277. Harvard Witberg, G., and Kornowski, R. (2015). Editorial commentNon-culprit lesion percutaneous coronary intervention during acute myocardial infarction – the road not taken?. Advances in Interventional Cardiology/Postępy w Kardiologii Interwencyjnej, 11(2), pp.71-73. https://doi.org/10.5114/pwki.2015.52277 MLA Witberg, Guy et al. "Editorial commentNon-culprit lesion percutaneous coronary intervention during acute myocardial infarction – the road not taken?." Advances in Interventional Cardiology/Postępy w Kardiologii Interwencyjnej, vol. 11, no. 2, 2015, pp. 71-73. doi:10.5114/pwki.2015.52277. Vancouver Witberg G, Kornowski R. Editorial commentNon-culprit lesion percutaneous coronary intervention during acute myocardial infarction – the road not taken?. Advances in Interventional Cardiology/Postępy w Kardiologii Interwencyjnej. 2015;11(2):71-73. doi:10.5114/pwki.2015.52277.

ST-Elevation Myocardial Infarction: Preventive Percutaneous Coronary Intervention in the Non-Culprit Vessel

Patients with ST-segment elevation myocardial infarction (STEMI) and multi-vessel disease (MVD) have poorer outcomes after primary percutaneous coronary intervention (PCI) compared to those with one-vessel coronary artery disease. Current STEMI guidelines recommend revascularization of the infarct related artery (IRA) only during primary PCI, while PCI for non-IRA lesions should be performed after objective evidence of residual ischemia. Evidence regarding the optimal management strategy for non-IRA lesions in STEMI patients with MVD has been limited and mainly based on retrospective, contradictory and probably biased data. A recently published randomized study, PRAMI, challenges the guidelines since preventive acute multi-vessel PCI for significant stenoses in non-IRAs has been associated with a reduction of major adverse cardiovascular events (MACE) compared to PCI limited to the IRA. A review of the literature and a discussion about the implications of the PRAMI study regarding the optimal revascularization strategy for STEMI with MVD are presented herein.

Comparative effects of percutaneous coronary intervention for infarct-related artery only or for both infarct- and non-infarct-related arteries in patients with ST-elevation myocardial infarction and multi-vessel disease

Rapid recanalization of infarct-related artery (IRA) has become the major target during primary percutaneous coronary intervention (PCI) for patients with ST-elevation myocardial infarction (MI), but strategy for treatment of non-IRA lesions in this setting remains unclear. This study aimed to compare long-term effects between PCI for IRA only and that for both IRA and non-IRA in ST-elevation MI patients with multi-vessel disease. A total of 242 eligible patients with ST-elevation MI and at least two diseased coronary arteries (luminal narrowing > or = 70%) undergoing primary PCI were included. Of them, 149 patients underwent primary PCI for IRA only (group 1), and 93 received primary PCI for IRA followed by elective PCI for non-IRA 7 to 15 days after acute myocardial infarction (AMI) (group 2). Drug-eluting stents (DESs) were deployed in more than 90% of the patients. The two groups did not differ with respect to baseline clinical and angiographic characteristics. No significant differences were observed in 12-month clinical follow-up results regarding major adverse cardiac events (11.5% vs 15.1%, P > 0.05) and target lesion revascularization (8.1% vs 7.6%, P > 0.05) between the two groups. However, patients in group 1 had higher rates of recurrent angina (10.1% vs 2.1%, P < 0.05) and depressed left ventricular ejection fraction evaluated by echocardiography (0.56 +/- 0.22 vs 0.63 +/- 0.25, P < 0.05). With the use of DESs, complete revascularization with elective PCI for non-IRA after primary PCI may exert a beneficial effect on long-term symptomatology and left ventricular function in patients with ST-elevation MI and multi-vessel disease.

Six-Month Angiographic Follow-up after Intravascualr Ultrasound Guided Stenting of Infarct Related Artery

Background and Objectives：Intracoronary Stenting has been established as an effective treatment modality for the reduction of restenosis in patients with acute myocardial infarction. This study was performed in order to evaluate the long-term outcomes of stenting for infarct-related artery (IRA lesions using intravascular ultrasound (IVUS and compare these results with the stenting of non infarct-related artery (non-IRA lesions. Subjects and Methods：IVUS-guided coronary stenting was successfully performed in 510 native coronary lesions (105 IRA vs. 405 non-IRA. A six-month angiography was performed in 419 lesions (82.2%： 87 IRA lesions (82.9% and 332 non-IRA lesions (82.0%. The results were evaluated using clinical, angiographic and IVUS methods. Results：There were no significant differences in the clinical and angiographic variables between the two groups. IVUS variables including reference vessel area and minimal stent area were also similar between the two groups. There was no significant difference in the angiographic restenosis rate between the two groups in cases of minimal stent area ≤7 mm 2 ：12.8% (6/47 in IRA vs. 19.1% (33/173 in non-IRA lesions (p＝0.315. However, the angiographic restenosis rate in cases of minimal stent area <7 mm 2 was 50% (20/40 in IRA lesions vs. 31.5% (50/159 in non-IRA lesions (p＝0.028. Conclusion：The rate of angiographic restenosis is significantly higher in stenting for IRA lesions as compared with that for non-IRA lesions in cases of minimal stent area <7 mm 2 . ( ( ( (Korean Circulation J 2002;32(4 :309-316

Six-month angiographic follow-up after intravascular ultrasound-guided stenting of infarct-related artery: Comparison with non–infarct-related artery

Background Compared with balloon angioplasty, stenting has been established as an effective treatment modality to reduce restenosis in patients with acute myocardial infarction. However, the immediate results that predict favorable long-term outcomes in the acute infarct stenting are unknown. Therefore, we evaluated long-term outcomes of stenting for infarct-related artery (IRA) lesions by using intravascular ultrasound (IVUS) compared with that of stenting for non-IRA lesions. Methods IVUS-guided coronary stenting was successfully performed in 510 native coronary lesions (105 IRA vs 405 non-IRA). A 6-month follow-up angiogram was performed in 419 (82.2%) lesions: 87 (82.9%) IRA lesions and 332 (82.0%) non-IRA lesions. Coronary stenting on the IRA lesions was successfully performed within 7 to 10 days after onset of infarction in 42 patients and within 12 hours in 45 patients. Results were evaluated by clinical, angiographic, and IVUS methods. Results There were no significant differences in clinical and angiographic variables between the two groups. IVUS variables including reference vessel area and minimal stent area were also similar between the two groups. There was no significant difference in angiographic restenosis rate between the two groups in cases of minimal stent area ≥7 mm2: 12.8% (6 of 47) in IRA versus 19.1% (33 of 173) in non-IRA lesions (P =.315). However, the angiographic restenosis rate in cases of minimal stent area <7 mm2 was 50% (20 of 40) in IRA lesions versus 31.5% (50 of 159) in non-IRA lesions (P =.028). Conclusions Angiographic restenosis is significantly higher in stenting for IRA lesions compared with that for non-IRA lesions in cases of minimal stent area <7 mm2. (Am Heart J 2001;141:832-6.)