Study Challenges Guidelines on Treating Heart Artery Lesions

Contrary to the recommendations of the American Heart Association, the American College of Cardiology, and the European Society of Cardiology (ESC), a UK study found it pays to treat more than the lesions in the "culprit" artery after a heart attack.

Contrary to the recommendations of the American Heart Association, the American College of Cardiology, and the European Society of Cardiology (ESC), a UK study found it pays to treat more than the lesions in the “culprit” artery after a heart attack.

Reporting on a study known as CvLPRIT, principal investigator Anthony Gershlick, MD, said performing PCI to remove lesions in non-involved arteries as well resulted in a 55% reduction in major adverse cardiac events (MACE).

Gershlick is a professor of interventional cardiology at the University of Leicester and consultant cardiologist at the University Hospitals of Leicester.

The study did not settle the question of whether there is also a benefit to removing significant stenosis in arteries not involved in the heart attack, Gershlick said at the meeting.

The research tracked 296 heart attack patients at 7 UK interventional cardiology centers. One group (146 patients) had revascularization only of the culprit artery while the other (150 patients) got complete revascularization.

A year after their procedures, one in five patients (21.1%) from the group in which only the culprit artery was treated had MACE. In the total revascularization group the MACE rate was 10%.

There were risks involved in performing the more complex procedure, Gershlick said. “Procedure time and contrast volume load were significantly higher in the complete revascularization group.”

It took on average 55 minutes to revascularize both arteries, versus 41 minutes for the culprit artery.

But the patients showed no increase in stroke, major bleeding, or kidney problems caused by using more contrast medium in the longer procedures.

The longer procedures required on average 250 ml of contrast medium and patients having the single artery procedures needed on average 190 ml of contrast medium.

At the meeting Gershlick said “the results demonstrate a statistically significant benefit from a strategy of complete revascularization,” instead of waiting. “A delayed staged outpatient strategy may not be as effective,” he said.