Timing of Complete Revascularization in Patients With ST-segment Elevation Myocardial Infarction … (NCT05231226) | Clinical Trial Compass
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Timing of Complete Revascularization in Patients With ST-segment Elevation Myocardial Infarction And Multivessel Disease
China426 participantsStarted 2022-03
Plain-language summary
At present, the two treatment strategies of opening non infarct related arteries (non IRA) simultaneously or by stages after emergency percutaneous coronary intervention (PCI) in patients with acute ST segment elevation myocardial infarction (STEMI) complicated with multi vessel disease (MVD) are still controversial. In our previous retrospective analysis, there was no significant difference between complete revascularization (CR) and staged CR at Anzhen Hospital in the cases of cardiac death, reinfarction, stroke, proportion of revascularization and hospitalization rate of heart failure.
Who can participate
Age range18 Years
SexALL
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Inclusion criteria
✓. Onset of the spontaneous acute STEMI (24 hours).
✓. The anatomical structure of coronary artery is suitable for complete revascularization by PCI.
✓. It is suitable for PCI through radial artery or femoral artery.
✓. Be able to fully identify Infarct-related artery（IRA）.
✓. In addition to IRA, in the vessels of lumen diameter is 2.25mm or more, but less than 4.5mm. there is at least one non IRA's stenosis more than 70% observed in both planes, or 50% \~ 69% stenosis and fractional flow reserve (FFR) or Quantitative Flow Ratio (QFR) measured value is 0.80 or less.
✓. After IRA revascularization the thrombolysis in myocardial infarction (TIMI) blood flow is in grade 3.
✓. The hemodynamics of patients after IRA revascularization is stable, that is, systolic blood pressure ≥ 90mmHg, or blood pressure ≥ 90mmHg after catecholamines, and there is no clinical manifestation of hypoperfusion.
✕. Cardiogenic shock which means a group of clinical syndromes leading to cardiac dysfunction caused by various reasons, which meet the following criteria: A: continuous hypotension, systolic blood pressure \< 90mmHg or mean arterial pressure decreased from baseline ≥ 30mmhg, more than 30min; B: cardiac index \< 1.8l/min/m2, pulmonary congestion or elevated left ventricular filling pressure; c: Signs of organ perfusion damage (at least one): changes in mental state, wet and cold skin, oliguria, and increased serum lactic acid level.
✕. The duration of cardiopulmonary resuscitation is more than 10 minutes.
✕. Emergency coronary artery bypass grafting (CABG) is needed.
✕. In stent restenosis, definition: A: target vessel diameter stenosis ≥ 50% at follow-up. b: The lumen loss at follow-up was larger than 50% of the net lumen gain after operation. c: The lumen diameter at follow-up and the minimum diameter loss measured immediately at stenting were 0.72 mm or more.