Primary Reperfusion Secondary Stenting Trial (PRIMACY)

Inclusion Criteria:

1. Age between 18 and 80 years;
2. ST-segment elevation myocardial infarction, presenting within 6 hours of symptoms onset, and persisting for more than 20 minutes;

3. High-risk STEMI as indicated by an ECG that fulfills any of the following three criteria:

   • ≥ 2 mm ST elevation in two anterior or lateral leads; or
   • ≥ 2 mm ST elevation in two inferior leads coupled with ST depression in two contiguous anterior leads for a total ST deviation of ≥ 8 mm; or
   • New left bundle branch block (LBBB) with at least 1 mm concordant ST elevation
4. Successful reperfusion (TIMI 3 flow) with a minimally invasive mechanical device (wire, thrombectomy, small size angioplasty catheter) persisting for more than 10 minutes
5. Infarct-related artery with a diameter above 2.5 mm.

Exclusion Criteria:

1. Prior STEMI in the qualifying artery;
2. Coronary dissection following reperfusion;
3. STEMI caused by acute stent thrombosis or a venous or arterial bypass graft occlusion;
4. Significant left main disease, as determined by angiography (≥ 50%) or other imaging technologies;
5. Cardiac condition requiring emergent or urgent surgical repair;
6. High risk of bleeding (need for systemic anticoagulation with vitamin K antagonist or other agents, severe thrombocytopenia, diathesis);
7. Contraindication to either ticagrelor, prasugrel or GpIIbIIIa inhibitors; including if prasugrel is selected age ≥ 75 years if , body weight < 60 kg and prior transient ischemic attacks, stroke, or intracranial hemorrhage;
8. STEMI with Killip III-IV or cardiogenic shock;
9. STEMI presenting with sudden death, ventricular fibrillation, or sustained ventricular tachycardia;
10. Pregnant or breastfeeding;
11. Chronic renal insufficiency (creatinine clearance < 50ml/min);
12. Contra-indication to percutaneous coronary intervention (severe uncontrolled iodine allergy, no vascular access available, intolerance to P2Y12 inhibitors);
13. Previous heart transplantation;
14. Any other conditions which in the opinion of the investigator, may either put the subject at risk or influence the result of the study (active cancer, risk for non-compliance, and risk for being lost to follow up);
15. Participation in another investigational drug or device study in the last 30 days.