Department of Cardiovascular Sciences, University of Leicester and Cardiovascular Theme, NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, United Kingdom.
Department of Cardiovascular Sciences, University of Leicester and Cardiovascular Theme, NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, United Kingdom.
J Am Coll Cardiol. 2019 Dec 24;74(25):3083-3094. doi: 10.1016/j.jacc.2019.10.033.
Randomized trials have shown that complete revascularization in patients with ST-segment elevation myocardial infarction (MI) with multivessel disease results in lower major adverse cardiovascular events (MACE) (all-cause death, MI, ischemia-driven revascularization, heart failure).
The goal of this study was to determine whether the benefits of complete revascularization are sustained long-term and their impact on hard endpoints.
CvLPRIT (Complete versus Lesion-only Primary PCI Trial) was a randomized trial of complete inpatient revascularization versus infarct-related artery revascularization only at the index admission. Randomized patients have been followed longer-term. The components of the original primary endpoint were collected from physical and electronic patient records, and from local databases for all readmissions.
The median follow-up (achieved in >90% patients) from randomization to first event or last follow-up was 5.6 years (0.0 to 7.3 years). The primary MACE endpoint rate at this time point was 24.0% in the complete revascularization group but 37.7% of the infarct-related artery-only group (hazard ratio: 0.57; 95% confidence interval: 0.37 to 0.87; p = 0.0079). The composite endpoint of all-cause death/MI was 10.0% in the complete revascularization group versus 18.5% in the infarct-related artery-only group (hazard ratio: 0.47; 95% confidence interval: 0.25 to 0.89; p = 0.0175). In a landmark analysis (from 12 months to final follow-up), there was no significant difference between MACE, death/MI, and individual components of the primary endpoint.
Long-term follow-up of the CvLPRIT trial shows that the significantly lower rate of MACE in the complete revascularization group, previously seen at 12 months, is sustained to a median of 5.6 years. A significant difference in composite all-cause death/MI favoring the complete revascularization was also observed. (Complete versus Lesion-only Primary PCI Trial; ISRCTN70913605).
随机试验表明，ST 段抬高型心肌梗死（STEMI）合并多支血管病变患者行完全血运重建可降低主要不良心血管事件（MACE）（全因死亡、心肌梗死、缺血驱动的血运重建、心力衰竭）发生率。
本研究旨在确定完全血运重建的获益是否长期持续及其对硬终点的影响。
CvLPRIT（完全血运重建与仅罪犯病变血运重建治疗试验）是一项随机试验，比较完全住院血运重建与首次入院时仅梗死相关动脉血运重建。随机分组患者进行了更长期的随访。原始主要终点的组成部分从体格检查和电子病历中收集，并从所有再入院的本地数据库中收集。
从随机分组到首次事件或最后一次随访的中位随访时间（>90%患者获得）为 5.6 年（0.0 至 7.3 年）。此时，完全血运重建组的主要 MACE 终点发生率为 24.0%，而梗死相关动脉仅血运重建组为 37.7%（风险比：0.57；95%置信区间：0.37 至 0.87；p=0.0079）。完全血运重建组的全因死亡/心肌梗死复合终点发生率为 10.0%，而梗死相关动脉仅血运重建组为 18.5%（风险比：0.47；95%置信区间：0.25 至 0.89；p=0.0175）。在里程碑分析（从 12 个月到最终随访）中，MACE、死亡/心肌梗死和主要终点的各个组成部分之间无显著差异。
CvLPRIT 试验的长期随访结果显示，完全血运重建组的 MACE 发生率显著降低，在 12 个月时已观察到，在中位随访 5.6 年时仍持续存在。也观察到完全血运重建组在全因死亡/心肌梗死复合终点方面具有显著优势。（完全血运重建与仅罪犯病变血运重建治疗试验；ISRCTN70913605）。
