Left ventricular outcomes following multivessel PCI vs. infarct artery-only PCI in patients with acute STEMI: the Glasgow PRAMI CMR sub-study

Abstract

Background: In the Randomized Trial of Preventive Angioplasty in Myocardial Infarction (PRAMI; ISRCTN73028481), compared with infarct-related artery (IRA)-only PCI, additional immediate multivessel PCI (MV-PCI) of non-IRA improved long term prognosis. We studied left ventricular (LV) outcomes in a pre-specified cardiac magnetic resonance (CMR) sub-study. Methods: In a single centre prospective sub-study, PRAMI participants were invited to undergo 1.5T CMR 1 week and 1 year after primary PCI. LV analysis was performed using semi-automated software by a clinician blinded to treatment group assignment and clinical outcomes. Data was analysed byan independent statistician. Results: Of 465 randomised trial participants in 6 UK hospitals, 138 (30%) were enrolled in Glasgow. Eighty patients (17%) (mean age 60 years, 76% male) underwent CMR initially (n=41 (51%) in the multi-vessel PCI group; n=39 (49%) in the IRA-only group). 69 (86%) of these patients had a follow up CMR scan at 1 year (n=7 lost to follow-up, n=4 deceased). See Table 1 for results. Conclusion: The CMR sub-study participants represented the majority of all randomised participants in our hospital, which included one third of the PRAMI trial population. LV function and volumes were similar at 1 week and 1 year post-intervention in survivors. The CMR sub-study suggests that the benefit of the preventive PCI strategy in PRAMI may not be mediated by any effects on LV function and remodelling. (Table presented) .