title: Randomized trial of complete versus lesion-only revascularization in patients undergoing primary percutaneous coronary intervention for STEMI and multivessel disease: the CvLPRIT trial.
abstract: BACKGROUND
  The optimal management of patients found to have multivessel disease while undergoing primary percutaneous coronary intervention (P-PCI) for ST-segment elevation myocardial infarction is uncertain.
  
  
  OBJECTIVE
  CvLPRIT (Complete versus Lesion-only Primary PCI trial) is a U.K. open-label randomized study comparing complete revascularization at index admission with treatment of the infarct-related artery (IRA) only.
  
  
  METHODS
  After they provided verbal assent and underwent coronary angiography, 296 patients in 7 U.K. centers were randomized through an interactive voice-response program to either in-hospital complete revascularization (n = 150) or IRA-only revascularization (n = 146). Complete revascularization was performed either at the time of P-PCI or before hospital discharge. Randomization was stratified by infarct location (anterior/nonanterior) and symptom onset (≤ 3 h or >3 h). The primary endpoint was a composite of all-cause death, recurrent myocardial infarction (MI), heart failure, and ischemia-driven revascularization within 12 months.
  
  
  RESULTS
  Patient groups were well matched for baseline clinical characteristics. The primary endpoint occurred in 10.0% of the complete revascularization group versus 21.2% in the IRA-only revascularization group (hazard ratio: 0.45; 95% confidence interval: 0.24 to 0.84; p = 0.009). A trend toward benefit was seen early after complete revascularization (p = 0.055 at 30 days). Although there was no significant reduction in death or MI, a nonsignificant reduction in all primary endpoint components was seen. There was no reduction in ischemic burden on myocardial perfusion scintigraphy or in the safety endpoints of major bleeding, contrast-induced nephropathy, or stroke between the groups.
  
  
  CONCLUSIONS
  In patients presenting for P-PCI with multivessel disease, index admission complete revascularization significantly lowered the rate of the composite primary endpoint at 12 months compared with treating only the IRA. In such patients, inpatient total revascularization may be considered, but larger clinical trials are required to confirm this result and specifically address whether this strategy is associated with improved survival.
authors.affiliation: Department of Cardiovascular Sciences, University of Leicester and National Institute of Health Research Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital, Leicester, United Kingdom. Electronic address: agershlick@aol.com.
authors.forename: Anthony H
authors.initials: AH
authors.lastname: Gershlick
authors.affiliation: Department of Cardiovascular Sciences, University of Leicester and National Institute of Health Research Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital, Leicester, United Kingdom.
authors.forename: Jamal Nasir
authors.initials: JN
authors.lastname: Khan
authors.affiliation: Department of Cardiology, Royal Derby Hospital, Derby, United Kingdom.
authors.forename: Damian J
authors.initials: DJ
authors.lastname: Kelly
authors.affiliation: Multidisciplinary Cardiovascular Research Centre and the Division of Cardiovascular and Diabetes Research, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom; Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom.
authors.forename: John P
authors.initials: JP
authors.lastname: Greenwood
authors.affiliation: Clinical Trials and Evaluation Unit, Royal Brompton & Harefield NHS Foundation Trust and Imperial College London, London, United Kingdom.
authors.forename: Thiagarajah
authors.initials: T
authors.lastname: Sasikaran
authors.affiliation: University Hospital Southampton and Faculty of Medicine, University of Southampton, Southampton, United Kingdom.
authors.forename: Nick
authors.initials: N
authors.lastname: Curzen
authors.affiliation: Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Blackman
authors.affiliation: Royal Brompton & Harefield NHS Trust, London, United Kingdom.
authors.forename: Miles
authors.initials: M
authors.lastname: Dalby
authors.affiliation: University Hospitals of Leicester NHS Trust, Leicester, United Kingdom.
authors.forename: Kathryn L
authors.initials: KL
authors.lastname: Fairbrother
authors.affiliation: National Institute for Health Research Cardiovascular Biomedical Research Unit, Royal Brompton & Harefield NHS Trust, London, United Kingdom.
authors.forename: Winston
authors.initials: W
authors.lastname: Banya
authors.affiliation: Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom.
authors.forename: Duolao
authors.initials: D
authors.lastname: Wang
authors.affiliation: Norfolk and Norwich University Hospitals NHS Foundation Trust and Norwich Medical School, University of East Anglia Norwich, United Kingdom.
authors.forename: Marcus
authors.initials: M
authors.lastname: Flather
authors.affiliation: Kettering General Hospital, Kettering, United Kingdom.
authors.forename: Simon L
authors.initials: SL
authors.lastname: Hetherington
authors.affiliation: Oxford Heart Centre, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford, United Kingdom.
authors.forename: Andrew D
authors.initials: AD
authors.lastname: Kelion
authors.affiliation: Royal Bournemouth Hospital, Bournemouth, United Kingdom.
authors.forename: Suneel
authors.initials: S
authors.lastname: Talwar
authors.affiliation: Royal Stoke University Hospital, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, Staffordshire, United Kingdom.
authors.forename: Mark
authors.initials: M
authors.lastname: Gunning
authors.affiliation: Norfolk and Norwich University Hospitals NHS Foundation Trust and Norwich Medical School, University of East Anglia Norwich, United Kingdom.
authors.forename: Roger
authors.initials: R
authors.lastname: Hall
authors.affiliation: The Heart Hospital, University College London Hospitals, London, United Kingdom.
authors.forename: Howard
authors.initials: H
authors.lastname: Swanton
authors.affiliation: Department of Cardiovascular Sciences, University of Leicester and National Institute of Health Research Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital, Leicester, United Kingdom.
authors.forename: Gerry P
authors.initials: GP
authors.lastname: McCann
mesh_terms: D000368:Aged; D017023:Coronary Angiography; D005260:Female; D006333:Heart Failure / Q000453:epidemiology; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000401:mortality / Q000628:therapy*; D009204:Myocardial Revascularization / Q000379:methods; D062645:Percutaneous Coronary Intervention / Q000379:methods*
keywords: complete revascularization; non-infarct-related lesion; primary percutaneous coronary angioplasty