Ischemia-guided vs routine non-culprit vessel angioplasty for patients with ST segment elevation myocardial infarction and multi-vessel disease: the IAEA SPECT STEMI trial

Autor: Ganesan Karthikeyan, Amalia Peix, Niveditha Devasenapathy, Amelia Jimenez-Heffernan, Saif-ul Haque, Carlo Rodella, Raffaele Giubbini, Erick Alexanderson Rosas, Elgin Ozkan, Yung Jih Felix Keng, João Vitola, Dragana Sobic-Saranovic, Manoj Soni, Leonardo López, Lázaro O. Cabrera, Santiago Camacho-Freire, Ana Manovel-Sanchez, Hesham Naeem, Shazia Fatima, Roberto Rinaldi, Isabel Carvajal-Juarez, Kerim Esenboga, Maurizio Dondi, Diana Paez
Rok vydání: 2022
Předmět:
Zdroj: Journal of Nuclear Cardiology.
ISSN: 1532-6551
1071-3581
DOI: 10.1007/s12350-022-03108-z
Popis: Background In patients with multi-vessel disease presenting with ST elevation myocardial infarction (STEMI), the efficacy and safety of ischemia-guided, vs routine non-culprit vessel angioplasty has not been adequately studied. Methods We conducted an international, randomized, non-inferiority trial comparing ischemia-guided non-culprit vessel angioplasty to routine non-culprit vessel angioplasty, following primary PCI for STEMI. The primary outcome was the between-group difference in percent ischemic myocardium at follow-up stress MPI. All MPI images were processed and analyzed at a central core lab, blinded to treatment allocation. Results In all, 109 patients were enrolled from nine countries. In the ischemia-guided arm, 25/48 (47%) patients underwent non-culprit vessel PCI following stress MPI. In the routine non-culprit PCI arm, 43/56 (77%) patients underwent angioplasty (86% within 6 weeks of randomization). The median percentage of ischemic myocardium on follow-up imaging (mean 16.5 months) was low, and identical (2.9%) in both arms (difference 0.13%, 95%CI − 1.3%–1.6%, P Conclusion A strategy of ischemia-guided non-culprit PCI resulted in low ischemia burden, and was non-inferior to a strategy of routine non-culprit vessel PCI in reducing ischemia burden. Selective non-culprit PCI following STEMI offers the potential for cost-savings, and may be particularly relevant to low-resource settings. (CTRI/2018/08/015384).
Databáze: OpenAIRE
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