title: Infarct size and left ventricular remodelling after preventive percutaneous coronary intervention.
abstract: 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.
  
  
  
  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.
  
  
  
  From 219 enrolled patients in two sites, 84% underwent CMR. 42 (50%) were randomised to culprit-artery-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/m2, 69.3 (59.4, 79.9) vs 66.1 (54.7, 73.7), p=0.48) and LV end-systolic volume (mL/m2, 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.
  
  
  
  Compared with culprit-only PCI, non-infarct-artery MI in the preventive PCI strategy was uncommon and LV volumes and ejection fraction were similar.
authors: BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK.|West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Dunbartonshire, UK.
authors: Kenneth
authors: K
authors: Mangion
authors: BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK.|West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Dunbartonshire, UK.
authors: David
authors: D
authors: Carrick
authors: BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK.|West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Dunbartonshire, UK.
authors: Barry W
authors: BW
authors: Hennigan
authors: BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK.|West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Dunbartonshire, UK.
authors: Alexander R
authors: AR
authors: Payne
authors: BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK.
authors: John
authors: J
authors: McClure
authors: West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Dunbartonshire, UK.
authors: Maureen
authors: M
authors: Mason
authors: Therapeutics and Cardiac Research Team, Freeman Hospital, Newcastle upon Tyne, UK.
authors: Rajiv
authors: R
authors: Das
authors: Therapeutics and Cardiac Research Team, Freeman Hospital, Newcastle upon Tyne, UK.
authors: Rebecca
authors: R
authors: Wilson
authors: Therapeutics and Cardiac Research Team, Freeman Hospital, Newcastle upon Tyne, UK.
authors: Richard J
authors: RJ
authors: Edwards
authors: BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK.|West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Dunbartonshire, UK.
authors: Mark C
authors: MC
authors: Petrie
authors: West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Dunbartonshire, UK.
authors: Margaret
authors: M
authors: McEntegart
authors: West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Dunbartonshire, UK.
authors: Hany
authors: H
authors: Eteiba
authors: BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK.|West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Dunbartonshire, UK.
authors: Keith G
authors: KG
authors: Oldroyd
authors: BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK.|West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Dunbartonshire, UK.
authors: Colin
authors: C
authors: Berry
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D056988:Anterior Wall Myocardial Infarction / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology / Q000628:therapy*; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D006801:Humans; D007049:Iatrogenic Disease; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000473:pathology*; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000379:methods*; D011446:Prospective Studies; D020127:Recovery of Function; D000072657:ST Elevation Myocardial Infarction / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology / Q000628:therapy*; D013318:Stroke Volume; D013997:Time Factors; D016896:Treatment Outcome; D006113:United Kingdom; D016277:Ventricular Function, Left; D020257:Ventricular Remodeling