Timing of Complete Revascularization for Multivessel Coronary Artery Disease in STEMI (MVD)
Myocardial Infarction
About this trial
This is an interventional treatment trial for Myocardial Infarction focused on measuring myocardial infarction, percutaneous coronary intervention, multivessel coronary artery disease, dobutamine stress echocardiography
Eligibility Criteria
Inclusion Criteria:
- Clinical and electrocardiographic signs of first ever ST elevation myocardial infarction (chest pain lasting less than 12 hours with persistent ST elevation of ≥ 1mm in two contiguous leads on ECG recording)
- Multivessel coronary artery disease (MVD) on initial coronary angiogram, defined as visually assessed stenosis of more than 70% of any of the non-culprit vessels
- Treated with primary PCI of infarct related artery (IRA) only.
Exclusion Criteria:
- Hemodynamically unstable patients defined as presence of cardiogenic shock, intraaortic balloon pump (IABP) implantation and mechanical ventilation prior, during and after primary PCI;
- Presence of significant valvular disease;
- Decision that patient needs to be treated with coronary artery bypass graft (CABG) and/or valvular replacement or reconstruction surgery after initial culprit only PCI;
- Myocardial infarction is caused by stent thrombosis:
- Chronic total occlusion of any of the coronary arteries on initial angiogram;
- Previously treated by CABG surgery;
- Estimated life expectancy less than one year.
Sites / Locations
- Military Medical Academy
- Clinical Hospital Center Zemun
- Clinical Center Kragujevac
- Institute for cardiovascular diseases Vojvodine
Arms of the Study
Arm 1
Arm 2
Arm 3
Experimental
Experimental
Active Comparator
complete PCI at initial hospitalization
complete PCI after 30 days
Dobutamine stress testing
Staged, complete revascularization of all non-culprit significant lesions in a single PCI session during initial hospitalization for ST elevation myocardial infarction
Staged, complete revascularization of all non-culprit significant lesions in a single PCI session after 30 days from initial hospitalization for ST elevation myocardial infarction
Revascularization by PCI or deferral of revascularization of non-culprit coronary artery lesions based on ischemia testing using Dobutamin stress echocardiography