Stenting More Than One Coronary Vessel After Heart Attack Doesn’t Add to Damage Interview with:
Dr Gerry McCann MD
Reader in Cardiovascular Imaging
Department of Cardiovascular Sciences
University of Leicester
Leicester UK

Medical Research: What is the background for this study?

Dr. McCann:  Cardiologists increasingly treat patients who suffer a large heart attack with an emergency procedure performed under local anaesthetic. The blocked artery that causes the heart attack is opened by inserting a small metal stent at the blockage. Up to 50% of patients treated in this way also have other narrowed heart arteries. Two recent studies (PRAMI and CvLPRIT) in patients with heart attacks and multiple narrowed arteries have suggested that treating all of the narrowed arteries (complete revascularization) may be better than just treating the blocked artery. However, there is concern that the longer procedure, and putting in more stents, may cause more injury to the heart.

Medical Research: What is the background for this study? What are the main findings

Dr. McCann:  We studied 203 patients having a heart attack who were randomly assigned to have only the blocked artery opened (105 patients) or complete revascularization during the initial hospitalization (98 patients) in the CvLPRIT study. We assessed the size of the heart attack and any smaller areas of damage using MRI scanning. Patients who were treated with complete revascularization were more likely to have evidence of more than 1 heart attack on the MRI than if only the blocked artery was treated (22% vs. 11% of patients). However, these additional heart attacks were generally small and the total percentage of the heart that was damaged was not increased (12.6% vs. 13.5%). The pumping function of the heart measured 3 days and 9 months after treatment was also similar with both treatments.

Medical Research: What should clinicians and patients take away from your report?

Dr. McCann: The results of this study provide reassurance that cardiologists treating patients with a heart attack can open more than one narrowed artery without increasing the total amount of heart damage.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. McCann: Larger clinical trials are needed to assess whether complete revascularization results in improved mortality and recurrent heart attacks compared to those who only have the blocked artery opened. In addition the timing of complete revascularization and whether this can be guided effectively by the functional effect of the additional narrowing is uncertain.

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Dr Gerry McCann MD (2015). Stenting More Than One Coronary Vessel After Heart Attack Doesn’t Add to Damage 

Last Updated on December 17, 2015 by Marie Benz MD FAAD