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Multivessel disease has been reported to occur between 40 and 60% of patients with ST-segment elevation myocardial infarction (STEMI) and has been associated to a worse prognosis. Multivessel revascularization offers a myriad of potential advantages as enhance of the collateral blood flow, greater myocardial salvage, the stabilization of other lesions that can be potentially vulnerable, and the achievement of a complete revascularization, factor that is associated with a better prognosis. On the other hand, the prolongation of procedural duration, the hazard of contrast induced nephropathy and the peri-procedural complications can limit the widespread of this practice.
To date, very few observational studies have focused in the multivessel revascularization with disparity of results. Whereas ones have observed an increase of adverse cardiovascular events and thus not recommend it, others have shown neutral results.
Stress echocardiography has been shown to be an adequate technique for the diagnosis of coronary artery disease and could be an appropriate tool for selecting the lesions that need to be revascularized because they induce large areas of ischemia. However, this technique has also limitations like the high operator-dependence.
Therefore, the investigators sought to study if the complete multivessel revascularization of patients with STEMI treated by means of primary percutaneous coronary intervention (PCI) has an impact on prognosis compared to a strategy of treating only those non-culprit lesions that produce large areas of ischemia in a stress test.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| complete multivessel revascularization | Experimental |
| |
| stress echo guided revascularization | Active Comparator |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| complete multivessel revascularization | Procedure | After a successful primary PCI these patients will undergo complete revascularization of non-culprit lesions in a staged procedure during the index admission |
| Measure | Description | Time Frame |
|---|---|---|
| Combined event of cardiovascular death/re-myocardial infarction/revascularization of any vessel/admission due to heart failure | one year |
| Measure | Description | Time Frame |
|---|---|---|
| Incidence of acute renal failure (contrast induced nephropathy) | Admission | |
| Cost analysis of both strategies | 1 year | |
| Death |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Rodrigo Estevez-Loureiro, MD | Contact | 981 17 80 31 | Rodrigo.Estevez.Loureiro@sergas.es |
| Name | Affiliation | Role |
|---|---|---|
| Rodrigo Estevez-Loureiro, MD | Interventional Cardiology. Complejo Hospitalario Universitario A Couna | Principal Investigator |
| Ramon Calvino-Santos, MD | Interventional Cardiology. Complejo Hospitalario A Couna | Study Chair |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Complejo Hospitalario Universitario A Coruna | Recruiting | A Coruña | A Coruna | 15006 | Spain |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 33257214 | Derived | Flores-Rios X, Calvino-Santos RA, Estevez-Loureiro R, Peteiro-Vazquez J, Salgado-Fernandez J, Rodriguez-Vilela A, Franco-Gutierrez R, Bouzas-Mosquera A, Rodriguez-Fernandez JA, Marzoa-Rivas R, Gonzalez-Juanatey C, Aldama-Lopez G, Pinon-Esteban P, Vazquez-Gonzalez N, Muniz-Garcia J, Vazquez-Rodriguez JM. Economic evaluation of complete revascularization versus stress echocardiography-guided revascularization in the STEACS with multivessel disease. Rev Esp Cardiol (Engl Ed). 2021 Dec;74(12):1054-1061. doi: 10.1016/j.rec.2020.09.028. Epub 2020 Nov 27. English, Spanish. | |
| 31554422 |
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| stress echocardiography and revascularization if required | Procedure | after successful primary PCI, this group will undergo a stress echo to evaluate the significance of non-culprit lesions. If large area of ischemia is demonstrated, the artery supplying that are will be revascularized. |
|
cardiovascular death |
| one year |
| re-myocardial infarction | one year |
| revascularization of any vessel | one year |
| admission due to heart failure | one year |
| Nicolas Vazquez-Gonzalez, MD | Interventional Cardiology. Complejo Hospitalario A Couna | Study Chair |
| Jorge Salgado-Fernandez, MD | Interventional Cardiology. Complejo Hospitalario A Couna | Study Chair |
| Pablo Pinon-Esteban, MD | Interventional Cardiology. Complejo Hospitalario A Couna | Study Chair |
| Guillermo Aldama-Lopez, MD | Interventional Cardiology. Complejo Hospitalario A Couna | Study Chair |
| Xacobe Flores-Rios, MD | Interventional Cardiology. Complejo Hospitalario A Couna | Study Chair |
| Jesus Peteiro, MD, PhD | Stress Echo Unit. Complejo Hospitalario A Couna | Study Chair |
| Alberto Bouzas-Mosquera, MD | Stress Echo Unit. Complejo Hospitalario A Couna | Study Chair |
| Jose Angel Rodriguez-Fernandez, MD | Coronary Care Unit. Complejo Hospitalario A Couna | Study Chair |
| Derived |
| Calvino-Santos R, Estevez-Loureiro R, Peteiro-Vazquez J, Salgado-Fernandez J, Rodriguez-Vilela A, Franco-Gutierrez R, Bouzas-Mosquera A, Rodriguez-Fernandez JA, Mesias-Prego A, Gonzalez-Juanatey C, Aldama-Lopez G, Pinon-Esteban P, Flores-Rios X, Soler-Martin R, Seoane-Pillado T, Vazquez-Gonzalez N, Muniz J, Vazquez-Rodriguez JM. 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. Circ Cardiovasc Interv. 2019 Oct;12(10):e007924. doi: 10.1161/CIRCINTERVENTIONS.119.007924. Epub 2019 Sep 26. |
| ID | Term |
|---|---|
| D009203 | Myocardial Infarction |
| ID | Term |
|---|---|
| D017202 | Myocardial Ischemia |
| D006331 | Heart Diseases |
| D002318 | Cardiovascular Diseases |
| D014652 | Vascular Diseases |
| D007238 | Infarction |
| D007511 | Ischemia |
| D010335 | Pathologic Processes |
| D013568 | Pathological Conditions, Signs and Symptoms |
| D009336 | Necrosis |
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