Reduced subsequent risk for patients treated with PCI in non-infarct arteries with major stenoses
TUESDAY, Sept. 3 (HealthDay News) -- For patients with acute ST-segment elevation myocardial infarction (STEMI), percutaneous coronary intervention (PCI) in non-infarct coronary arteries with major stenoses (preventive PCI) is associated with reduced subsequent cardiovascular risk, according to a study published online Sept. 1 in the New England Journal of Medicine to coincide with presentation at the annual European Society of Cardiology Congress, held from Aug. 31 to Sept. 4 in Amsterdam.
David S. Wald, M.D., from the Queen Mary University of London, and colleagues assessed the value of PCI in non-infarct coronary arteries with major stenoses. A total of 465 patients with acute STEMI who were undergoing infarct-artery PCI were randomized to preventive PCI or no preventive PCI (234 and 231 patients, respectively). The primary outcome was a composite of death from cardiac causes, nonfatal myocardial infarction, or refractory angina.
In January 2013, the results were considered conclusive and the trial was stopped early. During a mean follow-up of 23 months, the researchers found that the rate of primary outcome events was nine per 100 patients in the preventive-PCI group and 23 per 100 in the no-preventive-PCI group (hazard ratio in the preventive-PCI group, 0.35). The hazard ratios for the three components of the primary outcome were 0.34, 0.32, and 0.35, respectively.
"In conclusion, in this randomized trial, we found that in patients undergoing emergency infarct-artery PCI for acute STEMI, preventive PCI of stenoses in non-infarct arteries reduced the risk of subsequent adverse cardiovascular events, as compared with PCI limited to the infarct artery," the authors write.
Two authors disclosed an equity interest in Polypill.
Full Text (http://www.nejm.org/doi/full/10.1056/NEJMoa1305520?query=featured_home#t=article )Editorial (http://www.nejm.org/doi/full/10.1056/NEJMe1309383 )More Information ( http://www.escardio.org/ESC2013 )