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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EEmergency percutaneous coronary intervention (PCI) of an infarcted coronary artery is an efficacious treatment for patients with acute ST-segment elevation myocardial infarction (STEMI). However, the value of performing PCI on these arteries (preventive PCI) during primary PCI for STEMI is unknown. The objective of the Preventive Angioplasty in Myocardial Infarction trial [PRAMI; Wald DS et al. \u003Cem\u003EN Engl J Med 2013\u003C\/em\u003E] was to determine whether preventive PCI performed during the same procedure as the infarct-artery PCI would reduce the incidence of cardiac-related death, nonfatal MI, or refractory angina with evidence of ischemia.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EInterventional Techniques \u0026amp; Devices Cardiology Clinical Trials\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EMyocardial Infarction\u003C\/li\u003E\u003C\/ul\u003E\u003Cul class=\u0022kwd-group clinical-trial\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EInterventional Techniques \u0026amp; Devices\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ECardiology \u0026amp; Cardiovascular Medicine\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ECardiology Clinical Trials\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EMyocardial Infarction\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EEmergency percutaneous coronary intervention (PCI) of an infarcted coronary artery is an efficacious treatment for patients with acute ST-segment elevation myocardial infarction (STEMI). Patients presenting with STEMI commonly also have other, noninfarct-artery major stenoses. However, the value of performing PCI on these arteries (preventive PCI) during primary PCI for STEMI is unknown. Based on a lack of evidence for preventive PCI in patients with stable coronary artery disease, cardiovascular guidelines recommend against such practice. The objective of the Preventive Angioplasty in Myocardial Infarction trial [PRAMI; Wald DS et al. \u003Cem\u003EN Engl J Med\u003C\/em\u003E 2013], presented by David S. Wald, MD, Barts and the London Medical School, London, United Kingdom, was to determine whether preventive PCI performed during the same procedure as the infarctartery PCI would reduce the incidence of cardiac-related death, nonfatal MI, or refractory angina with evidence of ischemia.\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EA total of 465 consecutive patients with acute STEMI and multivessel coronary disease detected at the time of emergency PCI of the infarct artery were enrolled in this randomized, multicenter, single-blind study between 2008 and 2013. Multivessel disease was defined as \u0026gt;50% stenosis in one or more noninfarct arteries suitable for PCI. Ineligible patients included those with cardiogenic shock, prior coronary artery bypass graft surgery, \u0026gt;50% stenosis in either the left main or ostia of both the left anterior descending and circumflex arteries or if the only noninfarct stenosis was a chronic total occlusion. The patients were randomized after successful emergency PCI to preventive PCI (n=234) or no preventive PCI (n=231) in the noninfarct artery while they were still in the catheterization laboratory. The patients were examined and evaluated with electrocardiography at 6 weeks and annually thereafter.\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EBaseline characteristics were similar between the two groups. The mean age in both groups was 62 years, 76% were male, and the majority of infarcts involved the inferior wall, with approximately one-third anterior infarcts. The trial was stopped on January 24, 2013, due to a highly significant difference in the primary outcome in favor of preventive PCI (p\u0026lt;0.001).\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003EThe mean follow-up was 23 months. Ten patients in the preventive PCI group and 8 in the no preventive PCI group were lost to follow-up. The primary composite outcome occurred in 21 patients in the preventive PCI group (9.0%) and 53 patients in the no preventive PCI group (22.9%), with a risk reduction of 65% in the preventive PCI group (HR, 0.35; 95% CI, 0.21 to 0.58; p\u0026lt;0.001; \u003Ca id=\u0022xref-fig-1-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003EFigure 1\u003C\/a\u003E). This translates into an absolute risk reduction of \u223c14% or a number needed to treat of 7 patients to prevent one primary endpoint event at 1 year.\u003C\/p\u003E\u003Cdiv id=\u0022F1\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/13\/15\/12\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Cardiac Death, Nonfatal MI or Refractory Angina\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-1591751579\u0022 data-figure-caption=\u0022Cardiac Death, Nonfatal MI or Refractory Angina\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 1.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/13\/15\/12\/F1.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/13\/15\/12\/F1.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 1.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/13\/15\/12\/F1.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/13578\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption attrib\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 1.\u003C\/span\u003E \n            \u003Cp id=\u0022p-6\u0022 class=\u0022first-child\u0022\u003ECardiac Death, Nonfatal MI or Refractory Angina\u003C\/p\u003E\n         \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-1\u0022\u003EReproduced with permission from DS Wald, MD.\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-7\u0022\u003ECardiac death or nonfatal MI occurred in 11 (4.7%) patients in the preventive PCI group and 27 (11.7%) patients in the no preventive PCI group, with a risk reduction of 64% for patients treated with preventive PCI (HR, 0.36; 95% CI, 0.18 to 0.73; p=0.004). This translates into an absolute risk reduction of \u223c7% or a number needed to treat of 15 patients to prevent one cardiac death or nonfatal MI at 1 year.\u003C\/p\u003E\u003Cp id=\u0022p-8\u0022\u003EProcedure-related complications occurred in 10 patients in the preventive PCI group and 9 patients in the no preventive PCI group, and were composed of contrast nephropathy, bleeding requiring transfusion or surgery, and stroke. However, the trial was not powered to adequately compare the safety of these two strategies.\u003C\/p\u003E\u003Cp id=\u0022p-9\u0022\u003EThe results of the PRAMI trial demonstrate that preventive PCI performed in noninfarct arteries immediately after emergency PCI for STEMI provides a substantial cardiac benefit at 1 year. The robust results of this preventive PCI trial in the context of primary STEMI care are counter to current standards of care. Previously, due to uncertainty of the value of preventive PCI, its practice varied among cardiologists. It will be interesting to see whether the next iterations of major cardiovascular guidelines adopt the results of this trial.\u003C\/p\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2013 MD Conference Express\u00ae\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/13\/15\/12.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_figures.js?nznmw1\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nznmw1\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}