Long-term MACE risk reduced with complete revascularization: CvLPRIT
SAN DIEGO — Long-term data from the CvLPRIT trial support complete revascularization compared with PCI of the infarct-related artery only.
At 7 years, the rate of MACE, defined as death, MI, revascularization or HF, was 41.7% among patients who underwent PCI of the culprit lesion compared with 26.7% among patients who underwent complete revascularization (HR = 0.58; 95% CI, 0.38-0.87), according to results of an analysis of time to first event from randomization to long-term follow-up, and excluding events after 1 year among those who had an event during the first year, Anthony H. Gershlick, MD, professor of interventional cardiology at the University Hospitals of Leicester, U.K., reported at TCT 2018. Moreover, Gershlick said there was a cumulative signal of benefit in favor of complete revascularization for the combined endpoint of death and MI (11.6% vs. 21.6%; HR = 0.53; 95% CI, 0.29-0.97).
“There may be some benefit of complete revascularization when you add these two hard endpoints (death and MI) together,” Gershlick said.
Results of a landmark analysis from 12 months through long-term follow-up, excluding events that occurred after 1 year among patients who had an event during the first year, found that the rate of MACE was 24.3% among patients who underwent culprit-lesion-only PCI compared with 17.7% among those who underwent complete revascularization (HR = 0.71; 95% CI, 0.41-1.25). In an additional landmark analysis of all events that occurred during CvLPRIT, MACE was also increased with culprit lesion-only PCI (24.4% vs. 17.8%; HR = 0.8; 95% CI, 0.42-1.51).
The rate of repeat revascularization was low in both groups during follow-up and lower in the complete revascularization group, according to Gershlick.
“Complete revascularization appears to have the greatest impact in reducing events early in patients with STEMI and multivessel disease. After 12 months, the curves remain similar,” Gershlick said.
The CvLPRIT trial enrolled 296 patients in the United Kingdom with STEMI and multivessel disease. Median follow-up was 6 years.
Previously published 1-year data demonstrated better outcomes with complete revascularization. – by Katie Kalvaitis
Gershlick A. Keynote Interventional Studies II: Acute Coronary Syndromes, Cardiogenic Shock and Hemodynamic Support. Presented at: TCT Scientific Symposium; Sept. 21-25, 2018; San Diego.
Disclosure: Gershlick reports no relevant financial disclosures.