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Randomized Trial of Preventive Angioplasty in Myocardial Infarction Insight from PRAMI trial. - Dr. U.Barbero

In acute ST-segment elevation myocardial infarction (STEMI), the use of percutaneous coronary intervention (PCI) to treat the artery responsible for the infarct improves prognosis, but when there are other lesion than the infact related one the value of PCI in these arteries (preventive PCI) is unknown. Current guidelines advise to treat only the culprit lesion, so the aim of the Preventive Angioplasty in Acute Myocardial Infarction (PRAMI) trial, a single-blind, randomized study, was to determine whether performing preventive PCI as part of the primary PCI procedure to treat the infarct related artery would reduce the combined incidence of death from cardiac causes, nonfatal myocardial infarction, or refractory angina (primary end-point).
From 2008 through 2013, at five centers in the United Kingdom, they enrolled 465 patients with acute STEMI and after the completion of PCI in the infarct artery, eligible patients were randomly assigned to undergo no further PCI procedures or to undergo immediate preventive PCI in noninfarct arteries with more than 50% stenoses (preventive PCI). Subsequent PCI for angina was recommended only for refractory angina with objective evidence of ischemia. Then an intention-to-treat analysis was used. During a mean follow-up of 23 months, the primary outcome occurred in 21 patients assigned to preventive PCI and in 53 patients assigned to no preventive PCI which means rates of 9 events per 100 patients and 23 per 100, respectively (hazard ratio in the preventive-PCI group, 0.35; P<0.001) with hazard ratio 0.34 for death from cardiac causes, 0.32 for nonfatal myocardial infarction, and 0.35 for refractory angina.
Authors then concluded that in patients undergoing emergency infarct-artery PCI for acute STEMI, preventive PCI of stenoses in non culprit arteries reduced the risk of subsequent adverse cardiovascular events, as compared with PCI limited to the infarct artery.

writed  at 19-10-2013 17:19:08