Evidence map›Paper›PMID 23991625›Full record

Trial reportThe New England journal of medicine2013

Randomized trial of preventive angioplasty in myocardial infarction.

David S Wald, Joan K Morris, Nicholas J Wald, Alexander J Chase, Richard J Edwards, Liam O Hughes, Colin Berry, Keith G Oldroyd, PRAMI Investigators

6 registry-linked trialsOpen access · bronzeAbstract readMulticenter StudyRandomized Controlled Trial
PubMed Publisher
In one paragraph

Trial report in The New England journal of medicine, 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 6 registered trials, which are not on this map. Cited by 329 papers, 24 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
329citing papers in PubMed, 24 pooled it
70.0field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT03135275 nacompletednot on this mapstarted 2016, after this paper: background citation

MULTivessel Immediate Versus STAged RevaScularization in Acute Myocardial Infarction - The MULTISTARS AMI Trial

TypeinterventionalSponsorUniversity of ZurichRan2016 to 2023Enrolled840ConditionsST-elevation Myocardial Infarction, Multivessel Coronary DiseaseArmsStaged complete PCI, Immediate complete PCI, Synergy™ stent
NCT03138473 completednot on this mapstarted 2018, after this paper: background citation

Impact of Residual Syntax Score and Syntax Revascularization Index on Outcomes of Acute Coronary Syndrome Patients With Multi-Vessel Disease

TypeobservationalSponsorAssiut UniversityRan2018 to 2021Enrolled149ConditionsSTEMI - ST Elevation Myocardial Infarction, Multi Vessel Coronary Artery Disease, NSTEMI - Non-ST Segment Elevation MI, ACS - Acute Coronary SyndromeArmsResidual SYNTAX Score, SYNTAX Revascularization Index
NCT03621501 naactive not recruitingnot on this mapstarted 2018, after this paper: background citation

Percutaneous Complete Revascularization Strategies Using Sirolimus Eluting Biodegradable Polymer Coated Stents in Patients Presenting With Acute Coronary Syndrome and Multivessel Disease

TypeinterventionalSponsorErasmus Medical CenterRan2018 to 2026Enrolled1,525ConditionsAcute Coronary SyndromeArmsPercutaneous coronary intervention
NCT04259853 naunknown statusnot on this mapstarted 2020, after this paper: background citation

Quantitative Fractional Ratio-guided Non-culprit-vessel Revascularization in STEMI Patients With Multi-vessel Disease: a Prospective Multi-center Randomized Controlled Trial

TypeinterventionalSponsorFujian Medical UniversityRan2020 to 2026Enrolled1,016ConditionsST Elevation Myocardial Infarction, Multi-Vessel Coronary Artery StenosisArmsPCI
NCT04743154 nacompletednot on this mapstarted 2018, after this paper: background citation

In-hospital Versus After-discharge Complete Revascularization in STEMI Patients With Multivessel Disease.

TypeinterventionalSponsorHospital General Universitario de ValenciaRan2018 to 2022Enrolled250ConditionsSTEMI - ST Elevation Myocardial Infarction, Multivessel Coronary Artery DiseaseArmsIn-hospital nonculprit-lesions percutaneous coronary intervention (PCI), After-discharge nonculprit-lesions percutaneous coronary intervention (PCI)
NCT05231226 naunknown statusnot on this mapstarted 2022, after this paper: background citation

Timing of Complete Revascularization in Patients With ST-segment Elevation Myocardial Infarction And Multivessel Disease-A Multi-center Randomized Controlled Trial

TypeinterventionalSponsorBeijing Anzhen HospitalRan2022 to 2024Enrolled426ConditionsST-elevation Myocardial Infarction, Multivessel Coronary DiseaseArmsImmediately CR, Staged (within 45 days) CR
3 · Its place in the literature

Who cites it

329 citing papers in PubMed, 24 syntheses or guidelines pooled it, 1,029 citations in OpenAlex.

  1. Pooled it
  2. Pooled it
  3. Completeness, timing, and guidance of percutaneous coronary intervention for myocardial infarction and multivessel disease: a systematic review and network meta-analysis.EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology · 2025
    Pooled it
  4. Pooled it
  5. Pooled it
  6. Pooled it
  7. Pooled it
  8. Pooled it
  9. Pooled it
  10. Pooled it
  11. Pooled it
  12. Pooled it
  13. Pooled it
  14. Pooled it
  15. Pooled it
  16. Multivessel versus culprit-only PCI in STEMI patients with multivessel disease: meta-analysis of randomized controlled trials.Clinical research in cardiology : official journal of the German Cardiac Society · 2020
    Pooled it
  17. Pooled it
  18. Pooled it
  19. Pooled it
  20. Pooled it

269 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

9 authors at 6 institutions in 1 country.

David S WaldWolfson Institute of Preventive Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom. d.s.wald@qmul.ac.uk
Joan K Morris
Nicholas J Wald
Alexander J Chase
Richard J Edwards
Liam O Hughes
Colin Berry
Keith G Oldroyd
PRAMI Investigators
Golden Jubilee National Hospital · GBQueen Mary University of London · GBFreeman Hospital · GBLondon Chest Hospital · GBMorriston Hospital · GBNorfolk and Norwich University Hospital · GB

Funding

British Heart Foundation FS/12/55/29695
6 · The paper itself

Abstract

backgroundIn acute ST-segment elevation myocardial infarction (STEMI), the use of percutaneous coronary intervention (PCI) to treat the artery responsible for the infarct (infarct, or culprit, artery) improves prognosis. The value of PCI in noninfarct coronary arteries with major stenoses (preventive PCI) is unknown.

methodsFrom 2008 through 2013, at five centers in the United Kingdom, we enrolled 465 patients with acute STEMI (including 3 patients with left bundle-branch block) who were undergoing infarct-artery PCI and randomly assigned them to either preventive PCI (234 patients) or no preventive PCI (231 patients). Subsequent PCI for angina was recommended only for refractory angina with objective evidence of ischemia. The primary outcome was a composite of death from cardiac causes, nonfatal myocardial infarction, or refractory angina. An intention-to-treat analysis was used.

resultsBy January 2013, the results were considered conclusive by the data and safety monitoring committee, which recommended that the trial be stopped early. During a mean follow-up of 23 months, the primary outcome occurred in 21 patients assigned to preventive PCI and in 53 patients assigned to no preventive PCI (infarct-artery-only PCI), which translated into rates of 9 events per 100 patients and 23 per 100, respectively (hazard ratio in the preventive-PCI group, 0.35; 95% confidence interval [CI], 0.21 to 0.58; P<0.001). Hazard ratios for the three components of the primary outcome were 0.34 (95% CI, 0.11 to 1.08) for death from cardiac causes, 0.32 (95% CI, 0.13 to 0.75) for nonfatal myocardial infarction, and 0.35 (95% CI, 0.18 to 0.69) for refractory angina.

conclusionsIn patients with STEMI and multivessel coronary artery disease undergoing infarct-artery PCI, preventive PCI in noninfarct coronary arteries with major stenoses significantly reduced the risk of adverse cardiovascular events, as compared with PCI limited to the infarct artery. (Funded by Barts and the London Charity; PRAMI Current Controlled Trials number, ISRCTN73028481.).

Indexed as

Angioplasty, Balloon, CoronaryAdultAgedAged, 80 and overAngina PectorisCoronary StenosisFemaleFollow-Up StudiesHeart DiseasesHumansIntention to Treat AnalysisKaplan-Meier EstimateMaleMiddle AgedMyocardial InfarctionRisk

Identifiers

PMID23991625
OpenAlexW2132861593

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.