PRAMI
Trial question
What is the role of preventive PCI in patients with acute STEMI and multivessel coronary artery disease?
Study design
Multi-center
Open label
RCT
Population
Characteristics of study participants
22.0% female
78.0% male
N = 465
465 patients (102 female, 363 male).
Inclusion criteria: acute STEMI (including 3 patients with left bundle-branch block) and multivessel coronary artery disease detected at the time of emergency infarct artery PCI.
Key exclusion criteria: cardiogenic shock, previous CABG, a noninfarct artery stenosis ≥ 50% in the left main stem or the ostia of both the left anterior descending and circumflex arteries, or if the only noninfarct stenosis was a chronic total occlusion.
Interventions
N=234 preventive PCI (immediate preventive PCI in noninfarct arteries with > 50% stenoses).
N=231 no preventive PCI (no further PCI procedures).
Primary outcome
Death from cardiac causes, nonfatal MI, or refractory angina
9%
23%
23.0 %
17.3 %
11.5 %
5.8 %
0.0 %
Preventive
PCI
No preventive percutaneous coronary
intervention
Significant
decrease ▼
NNT = 7
Significant decrease in death from cardiac causes, nonfatal MI, or refractory angina (9% vs. 23%; HR 0.35, 95% CI 0.21 to 0.58).
Secondary outcomes
No significant difference in CV death (4 vs. 10; HR 0.34, 95% CI 0.11 to 1.08).
Significant decrease in nonfatal MI (7 vs. 20; HR 0.32, 95% CI 0.13 to 0.75).
Significant decrease in refractory angina (12 vs. 30; HR 0.35, 95% CI 0.18 to 0.69).
Conclusion
In acute STEMI (including 3 patients with left bundle-branch block) and multivessel coronary artery disease detected at the time of emergency infarct artery PCI, preventive PCI was superior to no preventive PCI with respect to death from cardiac causes, nonfatal MI, or refractory angina.
Reference
Wald DS, Morris JK, Wald NJ et al. Randomized trial of preventive angioplasty in myocardial infarction. N Engl J Med. 2013 Sep 19;369(12):1115-23.
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