Randomized Trial of Preventive Angioplasty
in Myocardial Infarction
David S. Wald, M.D., Joan K. Morris, Ph.D.
New England Journal of Medicine; 369:1115-23
19 September, 2013
R3 황인경 / pf.김명곤
Background
• Patients with acute ST-segment elevation myocardial
infarction (STEMI) are effectively treated with
percutaneous coronary intervention (PCI) to improve
prognosis
• However, the value of performing PCI in noninfarct
coronary arteries with major stenoses for the
prevention of future cardiac events is not known
Background
• The aim of this single-blind, randomized study, called
the Preventive Angioplasty in Acute Myocardial
Infarction (PRAMI) trial, was to determine whether
performing preventive PCI would reduce the
combined incidence of death from cardiac causes,
nonfatal myocardial infarction, or refractry angina
Methods
• Study design
– From April 2008 through January 2013
– Enrolled 465 patients at five coronary centers in the U.K.
• Study particpants
– Patients of any age with acute STEMI and multivessel
coronary disease detected at the time of emergency PCI
– Eligibility : the infarct artery had been treated successfully
and there was stenosis of ≥ 50% in one or more other
coronary arteries and the stenosis was treatable by PCI
– Ineligibility: cardiogenic shock, previous CABG, a noninfarct artery stenosis of ≥ 50% in the left main stem or the
ostia of both the LAD and LCX arteries or a chronic total
occlusion
Methods
• Study procedures and follow-up
– After the completion of PCI in the infarct artery, eligible
patients were randomly assigned to undergo no further PCI
or immediate preventive PCI in noninfarct arteries
– Only in cases of refractory angina was performed further PCI
– Follow-up information at 6 weeks and then yearly
• Study outcomes
– Primary outcomes : death from cardiac causes, nonfatal
myocardial infarction, or refractory angina
– Secondary outcomes : death from noncardiac causes and
repeat revascularization procedures (PCI or CABG)
2008. 4 ~ 2013. 1
Result
• Patients
Result
• Patients
Result
• Primary outcome
(9%)
(23%)
Result
• Primary outcome
Result
• Cardiac death
Result
• Nonfatal MI
• Refractory angina
Conclusion
• In 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
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