Evidence map›Paper›PMID 27842548›Full record

Trial reportJournal of cardiovascular magnetic resonance : official journal of the Society for Cardiovascular Magnetic Resonance2016

Infarct size following complete revascularization in patients presenting with STEMI: a comparison of immediate and staged in-hospital non-infarct related artery PCI subgroups in the CvLPRIT study.

Jamal N Khan, Sheraz A Nazir, John P Greenwood, Miles Dalby, Nick Curzen, Simon Hetherington, Damian J Kelly, Daniel Blackman, Arne Ring, Charles Peebles and 6 more

Abstract readComparative StudyMulticenter StudyRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Journal of cardiovascular magnetic resonance : official journal of the Society for Cardiovascular Magnetic Resonance, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
7citing papers in PubMed, 2 pooled it
–field-weighted citation impact
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.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

7 citing papers in PubMed, 2 syntheses or guidelines pooled it.

  1. Pooled it
  2. Pooled it
  3. Immediate versus staged revascularisation of non-culprit arteries in patients with acute coronary syndrome: a systematic review and meta-analysis.Netherlands heart journal : monthly journal of the Netherlands Society of Cardiology and the Netherlands Heart Foundation · 2022
    Review
  4. Observational
  5. Journal of Cardiovascular Magnetic Resonance 2017.Journal of cardiovascular magnetic resonance : official journal of the Society for Cardiovascular Magnetic Resonance · 2018
    Review
  6. Review
  7. Review of Journal of Cardiovascular Magnetic Resonance (JCMR) 2015-2016 and transition of the JCMR office to Boston.Journal of cardiovascular magnetic resonance : official journal of the Society for Cardiovascular Magnetic Resonance · 2017
    Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

16 authors.

Jamal N KhanDepartment of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Cardiovascular Biomedical Research Unit, University Hospitals of Leicester NHS Trust, Glenfield Hospital, Leicester, UK.
Sheraz A NazirDepartment of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Cardiovascular Biomedical Research Unit, University Hospitals of Leicester NHS Trust, Glenfield Hospital, Leicester, UK.
John P GreenwoodMultidisciplinary Cardiovascular Research Centre and The Division of Cardiovascular and Diabetes Research, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK.
Miles DalbyHarefield Hospital, Royal Brompton and Harefield Foundation Trust, NIHR Cardiovascular Biomedical Research Unit, Middlesex, UK.
Nick CurzenUniversity Hospital Southampton NHS Foundation Trust and University of Southampton, Southampton, UK.
Simon HetheringtonKettering General Hospital, Kettering, NN16 8UZ, UK.
Damian J KellyRoyal Derby Hospital, Derby, UK.
Daniel BlackmanMultidisciplinary Cardiovascular Research Centre and The Division of Cardiovascular and Diabetes Research, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK.
Arne RingLeicester Clinical Trials Unit, University of Leicester, UK and Department of Mathematical Statistics and Actuarial Science, University of Leicester, University of the Free State, Bloemfontein, South Africa.
Charles PeeblesUniversity Hospital Southampton NHS Foundation Trust and University of Southampton, Southampton, UK.
Joyce WongHarefield Hospital, Royal Brompton and Harefield Foundation Trust, NIHR Cardiovascular Biomedical Research Unit, Middlesex, UK.
Thiagarajah SasikaranHarefield Hospital, Royal Brompton and Harefield Foundation Trust, NIHR Cardiovascular Biomedical Research Unit, Middlesex, UK.
Marcus FlatherNorfolk and Norwich University Hospitals NHS Foundation Trust and Norwich Medical School, University of East Anglia, Norwich, UK.
Howard SwantonThe Heart Hospital, University College London Hospitals, London, UK.
Anthony H GershlickDepartment of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Cardiovascular Biomedical Research Unit, University Hospitals of Leicester NHS Trust, Glenfield Hospital, Leicester, UK.
Gerry P McCannDepartment of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Cardiovascular Biomedical Research Unit, University Hospitals of Leicester NHS Trust, Glenfield Hospital, Leicester, UK. gpm12@le.ac.uk.

Funding

British Heart Foundation SP/10/001/28194Department of Health CDF-2014-07-045Department of Health PDF-2011-04-051Medical Research Council MC_G1002675
6 · The paper itself

Abstract

backgroundThe CvLPRIT study showed a trend for improved clinical outcomes in the complete revascularisation (CR) group in those treated with an immediate, as opposed to staged in-hospital approach in patients with multivessel coronary disease undergoing primary percutaneous intervention (PPCI). We aimed to assess infarct size and left ventricular function in patients undergoing immediate compared with staged CR for multivessel disease at PPCI.

methodsThe Cardiovascular Magnetic Resonance (CMR) substudy of CvLPRIT was a multicentre, prospective, randomized, open label, blinded endpoint trial in PPCI patients with multivessel disease. These data refer to a post-hoc analysis in 93 patients randomized to the CR arm (63 immediate, 30 staged) who completed a pre-discharge CMR scan (median 2 and 4 days respectively) after PPCI. The decision to stage non-IRA revascularization was at the discretion of the treating interventional cardiologist.

resultsPatients treated with a staged approach had more visible thrombus (26/30 vs. 31/62, p = 0.001), higher SYNTAX score in the IRA (9.5, 8-16 vs. 8.0, 5.5-11, p = 0.04) and a greater incidence of no-reflow (23.3 % vs. 1.6 % p < 0.001) than those treated with immediate CR. After adjustment for confounders, staged patients had larger infarct size (19.7 % [11.7-37.6] vs. 11.6 % [6.8-18.2] of LV Mass, p = 0.012) and lower ejection fraction (42.2 ± 10 % vs. 47.4 ± 9 %, p = 0.019) compared with immediate CR.

conclusionsOf patients randomized to CR in the CMR substudy of CvLPRIT, those in whom the operator chose to stage revascularization had larger infarct size and lower ejection fraction, which persisted after adjusting for important covariates than those who underwent immediate CR. Prospective randomized trials are needed to assess whether immediate CR results in better clinical outcomes than staged CR.

trial registrationISRCTN70913605 , Registered 24th February 2011.

Indexed as

Magnetic Resonance ImagingVentricular Function, LeftAgedCoronary AngiographyCoronary Artery DiseaseFemaleHumansMaleMiddle AgedMyocardiumPatient SelectionPercutaneous Coronary InterventionPredictive Value of TestsProspective StudiesRisk FactorsST Elevation Myocardial InfarctionCardiovascular magnetic resonanceInfarct sizeMultivessel diseaseMyocardial infarctionPrimary percutaneous coronary intervention

Identifiers

PMID27842548
PMCPMC5109831

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Registered trials

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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.