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Coronary artery disease
Original article
Infarct size and left ventricular remodelling after preventive percutaneous coronary intervention
  1. Kenneth Mangion1,2,
  2. David Carrick1,2,
  3. Barry W Hennigan1,2,
  4. Alexander R Payne1,2,
  5. John McClure1,
  6. Maureen Mason2,
  7. Rajiv Das3,
  8. Rebecca Wilson3,
  9. Richard J Edwards3,
  10. Mark C Petrie1,2,
  11. Margaret McEntegart2,
  12. Hany Eteiba2,
  13. Keith G Oldroyd1,2,
  14. Colin Berry1,2
  1. 1BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
  2. 2West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Dunbartonshire, UK
  3. 3Therapeutics and Cardiac Research Team, Freeman Hospital, Newcastle upon Tyne, UK
  1. Correspondence to Professor Colin Berry, BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, 126 University Place, University of Glasgow, Glasgow G12 8TA, UK; colin.berry{at}glasgow.ac.uk

Abstract

Objective We hypothesised that, compared with culprit-only primary percutaneous coronary intervention (PCI), additional preventive PCI in selected patients with ST-elevation myocardial infarction with multivessel disease would not be associated with iatrogenic myocardial infarction, and would be associated with reductions in left ventricular (LV) volumes in the longer term.

Methods In the preventive angioplasty in myocardial infarction trial (PRAMI; ISRCTN73028481), cardiac magnetic resonance (CMR) was prespecified in two centres and performed (median, IQR) 3 (1, 5) and 209 (189, 957) days after primary PCI.

Results From 219 enrolled patients in two sites, 84% underwent CMR. 42 (50%) were randomised to culprit-artery-only PCI and 42 (50%) were randomised to preventive PCI. Follow-up CMR scans were available in 72 (86%) patients. There were two (4.8%) cases of procedure-related myocardial infarction in the preventive PCI group. The culprit-artery-only group had a higher proportion of anterior myocardial infarctions (MIs) (55% vs 24%). Infarct sizes (% LV mass) at baseline and follow-up were similar. At follow-up, there was no difference in LV ejection fraction (%, median (IQR), (culprit-artery-only PCI vs preventive PCI) 51.7 (42.9, 60.2) vs 54.4 (49.3, 62.8), p=0.23), LV end-diastolic volume (mL/m2, 69.3 (59.4, 79.9) vs 66.1 (54.7, 73.7), p=0.48) and LV end-systolic volume (mL/m2, 31.8 (24.4, 43.0) vs 30.7 (23.0, 36.3), p=0.20). Non-culprit angiographic lesions had low-risk Syntax scores and 47% had non-complex characteristics.

Conclusions Compared with culprit-only PCI, non-infarct-artery MI in the preventive PCI strategy was uncommon and LV volumes and ejection fraction were similar.

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/

https://doi.org/10.1136/heartjnl-2015-308660

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    Footnotes

    • Contributors CB and KGO made substantial contributions to conception and design. DC, ARP, MM, RD, RW, RJE, MCP, MMcE, HE, KGO and CB made substantial contributions to acquisition of data. KM, BWH, JMcC, KGO and CB made substantial contributions to the analysis and interpretation of data. KM, KGO and CB drafted the article. All authors were involved in revising it critically for important intellectual content. All authors gave final approval of the version to be submitted and any revised version. CB is responsible for the overall content as guarantor.

    • Funding CB was supported by the Scottish Funding Council. KM is supported by a Fellowship from the British Heart Foundation (FS/15/54/31639). BWH was supported by British Heart Foundation Project Grant PG/14/97/31263. National Health Service (Scotland) supported the costs of the CMR scans.

    • Competing interests CB holds a research agreement with Siemens Healthcare through the University of Glasgow. Relationships with industry: The University of Glasgow holds a research agreement with Siemens Healthcare

    • Ethics approval UK National Research Ethics Service.

    • Provenance and peer review Not commissioned; externally peer reviewed.