PRAMI TRIAL - CardiologyTrials.org

PRAMI TRIAL
Problem	STEMI
Format	Single-blinded multi-center randomised controlled trial
Treatment	PCI to non-culprit artery
Control	PCI to culprit artery only
Population	465 patients
Inclusion criteria	STEMI patients of any age with acute STEMI Multivessel coronary disease detected at the time of emergency PCI Patients were considered for eligibility after undergoing PCI in the infarct artery while they were in the catheterization laboratory They were deemed to be eligible if the infarct artery had been treated successfully and there was stenosis of 50% or more in one or more coronary arteries other than the infarct artery and the stenosis was deemed to be treatable by PCI. The treating cardiologist had to consider that both infarct-artery-only PCI and preventive PCI would be acceptable treatment options.
Exclusion criteria	Cardiogenic shock Unable to provide consent for any other reason Undergone previous coronary-artery bypass grafting (CABG) Noninfarct-artery stenosis of 50% or more in the left main stem or the ostia of both the left anterior descending and circumflex arteries (because these are indications for CABG) The only noninfarct stenosis was a chronic total occlusion (because it was felt that PCI in such circumstances was contraindicated owing to a low success rate).
Follow-up	Mean 23 months
Primary endpoint	Composite of death from cardiac causes, nonfatal myocardial infarction, or refractory angina
Secondary endpoint(s)	Components of primary endpoint Death from noncardiac causes Repeat revascularization procedures
Details
Brief summary:	PCI to non-culprit coronaries during PCI for STEMI reduced MI, angina and trend for reduced CV death

PAPER: Randomized trial of preventive angioplasty in myocardial infarction.
Date	19 Sep 2013
Journal	N Engl J Med. 2013 Sep 19;369(12):1115-23. doi: 10.1056/NEJMoa1305520.
Information	A single-blind study where patients were randomised to receiving additional PCI to non-culprit coronary stenoses >50%. Those receiving 'preventative' angioplasty to non-culprit vessels displayed a significant reduction in MI and angina and there was a trend towards reduced deaths. The trial was stopped early due to benefit.