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Angiographically Guided Complete Revascularization Versus Selective Stress Echocardiography-Guided Revascularization in Patients With ST-Segment-Elevation Myocardial Infarction and Multivessel Disease: The CROSS-AMI Randomized Clinical Trial.
Calviño-Santos, Ramón; Estévez-Loureiro, Rodrigo; Peteiro-Vázquez, Jesús; Salgado-Fernández, Jorge; Rodríguez-Vilela, Alejandro; Franco-Gutiérrez, Raúl; Bouzas-Mosquera, Alberto; Rodríguez-Fernández, José Ángel; Mesías-Prego, Alejandro; González-Juanatey, Carlos; Aldama-López, Guillermo; Piñón-Esteban, Pablo; Flores-Ríos, Xacobe; Soler-Martín, Rita; Seoane-Pillado, Teresa; Vázquez-González, Nicolás; Muñiz, Javier; Vázquez-Rodríguez, José Manuel.
Afiliação
  • Calviño-Santos R; Department of Cardiology, Hospital Universitario A Coruña, INIBIC, Spain (R.C.-S., J.P.-V., J.S.-F., A.B.-M., J.A.R.-F., G.A.-L., P.P.-E., X.F.-R., R.S.-M., T.S.-P., N.V.-G., J.M.V.-R.).
  • Estévez-Loureiro R; Department of Cardiology, Hospital Alvaro Cunqueiro, Vigo, Spain (R.E.-L.).
  • Peteiro-Vázquez J; Department of Cardiology, Hospital Universitario A Coruña, INIBIC, Spain (R.C.-S., J.P.-V., J.S.-F., A.B.-M., J.A.R.-F., G.A.-L., P.P.-E., X.F.-R., R.S.-M., T.S.-P., N.V.-G., J.M.V.-R.).
  • Salgado-Fernández J; CIBERCV (Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares), Instituto de Salud Carlos III, Madrid, Spain (J.P.-V., J.S.-F., A.B.-M., N.V.-G., J.M., J.M.V.-R.).
  • Rodríguez-Vilela A; Department of Cardiology, Hospital Universitario A Coruña, INIBIC, Spain (R.C.-S., J.P.-V., J.S.-F., A.B.-M., J.A.R.-F., G.A.-L., P.P.-E., X.F.-R., R.S.-M., T.S.-P., N.V.-G., J.M.V.-R.).
  • Franco-Gutiérrez R; CIBERCV (Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares), Instituto de Salud Carlos III, Madrid, Spain (J.P.-V., J.S.-F., A.B.-M., N.V.-G., J.M., J.M.V.-R.).
  • Bouzas-Mosquera A; Department of Cardiology, Hospital Universitario Arquitecto Marcide, Ferrol, Spain (A.R.-V., A.M.-P.).
  • Rodríguez-Fernández JÁ; Department of Cardiology, Hospital Universitario Lucus Augusti, Lugo, Spain (R.F.-G., C.G.-J.).
  • Mesías-Prego A; Department of Cardiology, Hospital Universitario A Coruña, INIBIC, Spain (R.C.-S., J.P.-V., J.S.-F., A.B.-M., J.A.R.-F., G.A.-L., P.P.-E., X.F.-R., R.S.-M., T.S.-P., N.V.-G., J.M.V.-R.).
  • González-Juanatey C; CIBERCV (Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares), Instituto de Salud Carlos III, Madrid, Spain (J.P.-V., J.S.-F., A.B.-M., N.V.-G., J.M., J.M.V.-R.).
  • Aldama-López G; Department of Cardiology, Hospital Universitario A Coruña, INIBIC, Spain (R.C.-S., J.P.-V., J.S.-F., A.B.-M., J.A.R.-F., G.A.-L., P.P.-E., X.F.-R., R.S.-M., T.S.-P., N.V.-G., J.M.V.-R.).
  • Piñón-Esteban P; Department of Cardiology, Hospital Universitario Arquitecto Marcide, Ferrol, Spain (A.R.-V., A.M.-P.).
  • Flores-Ríos X; Department of Cardiology, Hospital Universitario Lucus Augusti, Lugo, Spain (R.F.-G., C.G.-J.).
  • Soler-Martín R; Department of Cardiology, Hospital Universitario A Coruña, INIBIC, Spain (R.C.-S., J.P.-V., J.S.-F., A.B.-M., J.A.R.-F., G.A.-L., P.P.-E., X.F.-R., R.S.-M., T.S.-P., N.V.-G., J.M.V.-R.).
  • Seoane-Pillado T; Department of Cardiology, Hospital Universitario A Coruña, INIBIC, Spain (R.C.-S., J.P.-V., J.S.-F., A.B.-M., J.A.R.-F., G.A.-L., P.P.-E., X.F.-R., R.S.-M., T.S.-P., N.V.-G., J.M.V.-R.).
  • Vázquez-González N; Department of Cardiology, Hospital Universitario A Coruña, INIBIC, Spain (R.C.-S., J.P.-V., J.S.-F., A.B.-M., J.A.R.-F., G.A.-L., P.P.-E., X.F.-R., R.S.-M., T.S.-P., N.V.-G., J.M.V.-R.).
  • Muñiz J; Department of Cardiology, Hospital Universitario A Coruña, INIBIC, Spain (R.C.-S., J.P.-V., J.S.-F., A.B.-M., J.A.R.-F., G.A.-L., P.P.-E., X.F.-R., R.S.-M., T.S.-P., N.V.-G., J.M.V.-R.).
  • Vázquez-Rodríguez JM; Department of Cardiology, Hospital Universitario A Coruña, INIBIC, Spain (R.C.-S., J.P.-V., J.S.-F., A.B.-M., J.A.R.-F., G.A.-L., P.P.-E., X.F.-R., R.S.-M., T.S.-P., N.V.-G., J.M.V.-R.).
Circ Cardiovasc Interv ; 12(10): e007924, 2019 10.
Article em En | MEDLINE | ID: mdl-31554422
ABSTRACT

BACKGROUND:

Recent trials suggest that complete revascularization in patients with acute ST-segment-elevation myocardial infarction and multivessel disease is associated with better outcomes than infarct-related artery (IRA)-only revascularization. There are different methods to select non-IRA lesions for revascularization procedures. We assessed the clinical outcomes of complete angiographically guided revascularization versus stress echocardiography-guided revascularization in patients with ST-segment-elevation myocardial infarction.

METHODS:

We performed a randomized clinical trial in patients with multivessel disease who underwent a successful percutaneous coronary intervention of the IRA to test differences in prognosis (composite end point included cardiovascular mortality, nonfatal reinfarction, coronary revascularization, and readmission for heart failure after 12 months of follow-up) between complete angiographically guided revascularization (n=154) or stress echocardiography-guided revascularization (n=152) of the non-IRA lesions in an elective procedure before hospital discharge.

RESULTS:

The trial was prematurely stopped after the inclusion of 77% of the planned study population. As many as 152 (99%) patients in the complete revascularization group and 44 (29%) patients in the selective revascularization group required a percutaneous coronary intervention procedure of a non-IRA lesion before discharge. The primary end point occurred in 21 (14%) patients of the stress echocardiography-guided revascularization group and 22 (14%) patients of the complete angiographically guided revascularization group (hazard ratio, 0.95; 95% CI, 0.52-1.72; P=0.85).

CONCLUSIONS:

In patients with ST-segment-elevation myocardial infarction and multivessel disease, stress echocardiography-guided revascularization may not be significantly different to complete angiographically guided revascularization, thereby reducing the need for elective revascularization before hospital discharge. CLINICAL TRIAL REGISTRATION URL https//www.clinicaltrials.gov. Unique identifier NCT01179126.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Doença da Artéria Coronariana / Angiografia Coronária / Vasos Coronários / Ecocardiografia sob Estresse / Intervenção Coronária Percutânea / Infarto do Miocárdio com Supradesnível do Segmento ST Tipo de estudo: Clinical_trials / Etiology_studies / Prognostic_studies / Risk_factors_studies Limite: Aged / Female / Humans / Male / Middle aged País/Região como assunto: Europa Idioma: En Revista: Circ Cardiovasc Interv Assunto da revista: ANGIOLOGIA / CARDIOLOGIA Ano de publicação: 2019 Tipo de documento: Article
Texto completo
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Buscar no Google

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Doença da Artéria Coronariana / Angiografia Coronária / Vasos Coronários / Ecocardiografia sob Estresse / Intervenção Coronária Percutânea / Infarto do Miocárdio com Supradesnível do Segmento ST Tipo de estudo: Clinical_trials / Etiology_studies / Prognostic_studies / Risk_factors_studies Limite: Aged / Female / Humans / Male / Middle aged País/Região como assunto: Europa Idioma: En Revista: Circ Cardiovasc Interv Assunto da revista: ANGIOLOGIA / CARDIOLOGIA Ano de publicação: 2019 Tipo de documento: Article