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; Estevez Loureiro, Rodrigo; PETEIRO VAZQUEZ, JESUS CARLOS; SALGADO FERNANDEZ, JORGE; Rodríguez Vilela, Alejandro; Franco-Gutiérrez, Raúl; Bouzas-Mosquera, Alberto; Rodríguez-Fernández, José Ángel; Mesías Prego, José Alejandro; González Juanatey, Carlos; Aldama-López, Guillermo; Piñón Esteban, Pablo; FLORES RIOS, XACOBE; Soler Martin, Rita; Seoane Pillado, María Teresa; Vázquez González, Nicolás; Muñiz García, Javier; Vázquez Rodríguez, José Manuel
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Identificadores
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Fecha de publicación
2019Título de revista
Circ Cardiovasc Interv
Tipo de contenido
Artigo
DeCS
prueba de esfuerzo | factores de riesgo | ecocardiografía | pruebas de valores predictivos | mediana edad | vasos coronarios | anciano | reingreso de pacientes | recurrencia | angiografía coronaria | humanos | enfermedad arterial coronaria | insuficiencia cardíaca | cirugía coronaria percutánea | terminación temprana de ensayos clínicosMeSH
Risk Factors | Middle Aged | Exercise Test | Patient Readmission | Predictive Value of Tests | Echocardiography | Percutaneous Coronary Intervention | Coronary Angiography | Humans | Coronary Artery Disease | Recurrence | Aged | Coronary Vessels | Early Termination of Clinical Trials | Heart FailureResumen
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.