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Which One Should be Treated in the Setting of Acute ST Elevation Myocardial Infarction - Culprit Lesion or Culprit Vessel?

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ClinicalTrials.gov Identifier: NCT02356510
Recruitment Status : Completed
First Posted : February 5, 2015
Last Update Posted : February 5, 2015
Sponsor:
Information provided by (Responsible Party):
Ugur ARSLAN, Samsun Education and Research Hospital

Brief Summary:
The current guidelines still recommend emergent PCI of the culprit lesion and state that primary PCI should be limited to the culprit vessel with the exception of cardiogenic shock and persistent ischaemia after PCI of the supposed culprit lesion. This recommendation is based on a high number of studies. However, several studies are present about the safety and efficacy of non-culprit vessel PCI during acute MI. Nowadays, the debate is increasingly going on about the PCI of the non-culprit arteries during the index event with newer prospective randomized studies. Besides, it is still unclear for the culprit artery whether to treat only the culprit lesion or all the other lesions in the culprit vessel during the index event. The present report describes a retrospective comparison between the two strategies during primary PCI for STEMI, looking for their influence on the clinical and angiographic course of the patients.

Condition or disease Intervention/treatment
Myocardial Infarction Procedure: Primary PCI

  Show Detailed Description

Study Type : Observational
Actual Enrollment : 637 participants
Observational Model: Cohort
Time Perspective: Retrospective
Study Start Date : June 2014
Actual Primary Completion Date : February 2015

Resource links provided by the National Library of Medicine

MedlinePlus related topics: Heart Attack

Group/Cohort Intervention/treatment
Culprit lesion
Patients who underwent culprit lesion only PCI during primary intervention
Procedure: Primary PCI
Culprit vessel
Patients who underwent culprit lesion only PCI during primary intervention
Procedure: Primary PCI



Primary Outcome Measures :
  1. MACE [ Time Frame: 18 months ]


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Ages Eligible for Study:   30 Years to 80 Years   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Sampling Method:   Non-Probability Sample
Study Population
This multi-centre retrospective study included patients from 3 high-volume primary PCI centres in Turkey. A total number of 5512 patients underwent emergent PCI for acute STEMI between January 2011 and December 2013. From this patient population, patients were looked for the presence of an additional lesion to the culprit lesion (CL). Additional lesion was defined as the presence of an angiographically severe (≥70%) lesion other than the CL either proximal or distal to it in the same coronary artery after the distal flow was observed most commonly as a result of guide-wire passage or PTCA of the total occlusion.
Criteria

Inclusion Criteria:

  • Patients who underwent primary PCI for acute STEMI and had >1 lesion in the culprit artery

Exclusion Criteria:

  • Presence of LMCA lesion
  • Cardiogenic shock
  • Previous CABG operation
  • Decision for CABG operation after primary PCI
  • Severe valvular disease including aortic stenosis of mitral insufficiency
  • Severe kidney disease (serum creatinine >2.5 mg/dl or patients on maintenance hemodialysis)
  • Rejection of second PCI by the patient after the index event

Responsible Party: Ugur ARSLAN, Associate Proffessor of Cardiology, Head of Department, Samsun Education and Research Hospital
ClinicalTrials.gov Identifier: NCT02356510     History of Changes
Other Study ID Numbers: SamsunERH
First Posted: February 5, 2015    Key Record Dates
Last Update Posted: February 5, 2015
Last Verified: February 2015

Keywords provided by Ugur ARSLAN, Samsun Education and Research Hospital:
myocardial infarction
TIMI flow
culprit lesion
culprit vessel

Additional relevant MeSH terms:
Infarction
Myocardial Infarction
ST Elevation Myocardial Infarction
Ischemia
Pathologic Processes
Necrosis
Myocardial Ischemia
Heart Diseases
Cardiovascular Diseases
Vascular Diseases
Glucuronyl glucosamine glycan sulfate
Anticoagulants
Hypolipidemic Agents
Antimetabolites
Molecular Mechanisms of Pharmacological Action
Lipid Regulating Agents
Fibrinolytic Agents
Fibrin Modulating Agents
Hypoglycemic Agents
Physiological Effects of Drugs