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Infarct burden following multivessel PCI vs. infarct-only PCI in patients with acute STEMI: the Glasgow PRAMI CMR sub-study
Journal of Cardiovascular Magnetic Resonance volume 17, Article number: O9 (2015)
In the Preventive Angioplasty in Myocardial Infarction trial (PRAMI; ISRCTN73028481), immediate multivessel PCI (MV-PCI) of non-IRA (infarct related artery) lesions in patients with acute ST elevation myocardial infarction (STEMI) and multivessel coronary disease (MVD) improved long term prognosis. We assessed infarct distribution and size in a pre-specified cardiac magnetic resonance (CMR) sub-study.
In this single centre prospective sub-study, PRAMI participants were invited to undergo 1.5 Tesla CMR 1 week and 1 year after primary PCI. The CMR scans were analysed using semi-automated software by a clinician blinded to treatment group assignment and clinical outcomes. The presence and extent of infarction were assessed quantitatively with late gadolinium enhancement (LGE) imaging (Gadovist, 0.1 mmol/kg). The infarct was delineated as an area of myocardial enhancement (cm2) using a signal intensity threshold of >5SDs above a remote region, and expressed as a % of total LV mass. The incidence of new LGE in non-infarct related artery territories at baseline and 1 year were assessed. Data were analysed by an independent statistician.
Of 465 randomised trial participants in 6 UK hospitals, 138 (30%) were enrolled in Glasgow. Of these 80 patients underwent CMR 1 week post primary PCI of whom 41 (51%) were in the multi-vessel PCI group and 39 (49%) were in the IRA-only group. At 1 year, 69 (86%) patients had a follow up CMR scan. Infarct size and distribution are described in Table 1.
Infarct size and distribution were similar in patients treated by MV-PCI or IRA-only PCI. MV-PCI is not associated with additional MI acutely which supports the safety of this procedure in line with the benefits observed with preventive PCI in PRAMI.
Golden Jubilee National Hospital; PRAMI was funded by Barts and the London Charity.
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Mangion, K., Carrick, D., Payne, A.R. et al. Infarct burden following multivessel PCI vs. infarct-only PCI in patients with acute STEMI: the Glasgow PRAMI CMR sub-study. J Cardiovasc Magn Reson 17, O9 (2015). https://doi.org/10.1186/1532-429X-17-S1-O9
- Infarct Size
- Cardiac Magnetic Resonance
- Late Gadolinium Enhancement
- Infarct Related Artery
- Acute STEMI