Published in:
Open Access
25-10-2022 | ST-Segment Elevation Myocardial Infarction | Original Article
Ischemia-guided vs routine non-culprit vessel angioplasty for patients with ST segment elevation myocardial infarction and multi-vessel disease: the IAEA SPECT STEMI trial
Authors:
Ganesan Karthikeyan, MD, DM, MSc, Amalia Peix, MD, PhD, Niveditha Devasenapathy, MBBS, MSc, PhD, Amelia Jimenez-Heffernan, MD, PhD, Saif-ul Haque, MBBS, FCPS, Carlo Rodella, PhD, Raffaele Giubbini, MD, Erick Alexanderson Rosas, MD, Elgin Ozkan, MD, Yung Jih Felix Keng, MBBS, FRCP, MMed, João Vitola, MD, Dragana Sobic-Saranovic, MD, PhD, Manoj Soni, BSc, MSc, MPS, Leonardo López, MD, MSc, Lázaro O. Cabrera, MD, Santiago Camacho-Freire, MD, Ana Manovel-Sanchez, MD, Hesham Naeem, MBBS, FCPS, Shazia Fatima, MBBS, MS, FCPS, Roberto Rinaldi, NMT, Isabel Carvajal-Juarez, MD, Kerim Esenboga, MD, Maurizio Dondi, MD, Diana Paez, MD, MsEd
Published in:
Journal of Nuclear Cardiology
|
Issue 3/2023
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Abstract
Background
In patients with multi-vessel disease presenting with ST elevation myocardial infarction (STEMI), the efficacy and safety of ischemia-guided, vs routine non-culprit vessel angioplasty has not been adequately studied.
Methods
We conducted an international, randomized, non-inferiority trial comparing ischemia-guided non-culprit vessel angioplasty to routine non-culprit vessel angioplasty, following primary PCI for STEMI. The primary outcome was the between-group difference in percent ischemic myocardium at follow-up stress MPI. All MPI images were processed and analyzed at a central core lab, blinded to treatment allocation.
Results
In all, 109 patients were enrolled from nine countries. In the ischemia-guided arm, 25/48 (47%) patients underwent non-culprit vessel PCI following stress MPI. In the routine non-culprit PCI arm, 43/56 (77%) patients underwent angioplasty (86% within 6 weeks of randomization). The median percentage of ischemic myocardium on follow-up imaging (mean 16.5 months) was low, and identical (2.9%) in both arms (difference 0.13%, 95%CI − 1.3%–1.6%, P < .0001; non-inferiority margin 5%).
Conclusion
A strategy of ischemia-guided non-culprit PCI resulted in low ischemia burden, and was non-inferior to a strategy of routine non-culprit vessel PCI in reducing ischemia burden. Selective non-culprit PCI following STEMI offers the potential for cost-savings, and may be particularly relevant to low-resource settings.
(CTRI/2018/08/015384).