Culprit-first PCI
Trial question
What is the role of culprit lesion PCI before complete coronary angiography in patients with STEMI?
Study design
Single center
Open label
RCT
Population
Characteristics of study participants
16.0% female
84.0% male
N = 184
184 patients (29 female, 155 male).
Inclusion criteria: patients with STEMI.
Key exclusion criteria: history of CABG and arrival at the catheterization laboratory with cardiogenic shock; requirement of CPR; receipt of ECMO.
Interventions
N=90 culprit lesion PCI before complete coronary angiography (cardiac catheterization started with a PCI to the culprit artery).
N=94 complete coronary angiography followed by culprit lesion PCI (cardiac catheterization started with a complete diagnostic angiography).
Primary outcome
Needle-to-balloon time < 10 minutes
51.1%
19.1%
51.1 %
38.3 %
25.6 %
12.8 %
0.0 %
Culprit lesion PCI before complete coronary
angiography
Complete coronary angiography followed by culprit lesion
PCI
Significant
increase ▲
NNT = 3
Significant increase in needle-to-balloon time < 10 minutes (51.1% vs. 19.1%; OR 4.4, 95% CI 2.2 to 9.1).
Secondary outcomes
No significant difference in ventricular arrhythmia (22.2% vs. 17%; RR 1.31, 95% CI -1.52 to 4.14).
No significant difference in hemodynamic and/or respiratory support (15.6% vs. 17%; RR 0.92, 95% CI -5.47 to 7.31).
Borderline significant decrease in acute stent thrombosis (1.1% vs. 4.3%; RR 0.26, 95% CI -0.14 to 0.66).
Conclusion
In patients with STEMI, culprit lesion PCI before complete coronary angiography was superior to complete coronary angiography followed by culprit lesion PCI with respect to a needle-to-balloon time < 10 minutes.
Reference
Nir Levi, Rafael Wolff, Rami Jubeh et al. Culprit Lesion Coronary Intervention Before Complete Angiography in ST-Elevation Myocardial Infarction: A Randomized Clinical Trial. JAMA Netw Open. 2024 Mar 4;7(3):e243729.
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