PMID- 36284033
OWN - NLM
STAT- MEDLINE
DCOM- 20230614
LR  - 20240130
IS  - 1532-6551 (Electronic)
IS  - 1071-3581 (Print)
IS  - 1071-3581 (Linking)
VI  - 30
IP  - 3
DP  - 2023 Jun
TI  - Ischemia-guided vs routine non-culprit vessel angioplasty for patients with ST 
      segment elevation myocardial infarction and multi-vessel disease: the IAEA SPECT 
      STEMI trial.
PG  - 1091-1102
LID - 10.1007/s12350-022-03108-z [doi]
AB  - BACKGROUND: In patients with multi-vessel disease presenting with ST elevation 
      myocardial infarction (STEMI), the efficacy and safety of ischemia-guided, vs 
      routine non-culprit vessel angioplasty has not been adequately studied. METHODS: 
      We conducted an international, randomized, non-inferiority trial comparing 
      ischemia-guided non-culprit vessel angioplasty to routine non-culprit vessel 
      angioplasty, following primary PCI for STEMI. The primary outcome was the 
      between-group difference in percent ischemic myocardium at follow-up stress MPI. 
      All MPI images were processed and analyzed at a central core lab, blinded to 
      treatment allocation. RESULTS: In all, 109 patients were enrolled from nine 
      countries. In the ischemia-guided arm, 25/48 (47%) patients underwent non-culprit 
      vessel PCI following stress MPI. In the routine non-culprit PCI arm, 43/56 (77%) 
      patients underwent angioplasty (86% within 6 weeks of randomization). The median 
      percentage of ischemic myocardium on follow-up imaging (mean 16.5 months) was 
      low, and identical (2.9%) in both arms (difference 0.13%, 95%CI - 1.3%-1.6%, 
      P < .0001; non-inferiority margin 5%). CONCLUSION: A strategy of ischemia-guided 
      non-culprit PCI resulted in low ischemia burden, and was non-inferior to a 
      strategy of routine non-culprit vessel PCI in reducing ischemia burden. Selective 
      non-culprit PCI following STEMI offers the potential for cost-savings, and may be 
      particularly relevant to low-resource settings. (CTRI/2018/08/015384).
CI  - (c) 2022. The Author(s).
FAU - Karthikeyan, Ganesan
AU  - Karthikeyan G
AD  - Department of Cardiology, All India Institute of Medical Sciences, New Delhi, 
      India. karthik2010@gmail.com.
AD  - Cardiothoracic Sciences Centre, All India Institute of Medical Sciences, 24, 7th 
      Floor, New Delhi, 110029, India. karthik2010@gmail.com.
FAU - Peix, Amalia
AU  - Peix A
AD  - Department of Nuclear Medicine, Cardiology and Cardiovascular Surgery Institute, 
      Havana, Cuba.
FAU - Devasenapathy, Niveditha
AU  - Devasenapathy N
AD  - The George Institute for Global Health, New Delhi, India.
FAU - Jimenez-Heffernan, Amelia
AU  - Jimenez-Heffernan A
AD  - Hospital Universitario Juan Ramon Jimenez, Huelva, Spain.
FAU - Haque, Saif-Ul
AU  - Haque SU
AD  - Nuclear Medicine, Oncology and Radiotherapy Institute (NORI), Islamabad, 
      Pakistan.
FAU - Rodella, Carlo
AU  - Rodella C
AD  - Health Physics Department, ASST-Spedali Civili, Brescia, Italy.
FAU - Giubbini, Raffaele
AU  - Giubbini R
AD  - Nuclear Medicine, University of Brescia and Spedali Civili Brescia, Brescia, 
      Italy.
FAU - Rosas, Erick Alexanderson
AU  - Rosas EA
AD  - National Institute of Cardiology Ignacio Chavez, Mexico City, Mexico.
AD  - Department of Physiology, Faculty of Medicine, Universidad Nacional Autonoma de 
      Mexico, Mexico City, Mexico.
FAU - Ozkan, Elgin
AU  - Ozkan E
AD  - Department of Nuclear Medicine, Medical School, Ankara University, Ankara, 
      Turkey.
FAU - Keng, Yung Jih Felix
AU  - Keng YJF
AD  - Department of Cardiology, National Heart Centre Singapore, Singapore, Singapore.
FAU - Vitola, Joao
AU  - Vitola J
AD  - Quanta Diagnostico por Imagem, Curitiba, Brazil.
FAU - Sobic-Saranovic, Dragana
AU  - Sobic-Saranovic D
AD  - Faculty of Medicine, University of Belgrade, Belgrade, Serbia.
AD  - Center for Nuclear Medicine, University Clinical Centre of Serbia (UCCS), 
      Belgrade, Serbia.
FAU - Soni, Manoj
AU  - Soni M
AD  - The George Institute for Global Health, New Delhi, India.
FAU - Lopez, Leonardo
AU  - Lopez L
AD  - Department of Interventional Cardiology, Cardiology and Cardiovascular Surgery 
      Institute, Havana, Cuba.
FAU - Cabrera, Lazaro O
AU  - Cabrera LO
AD  - Department of Nuclear Medicine, Cardiology and Cardiovascular Surgery Institute, 
      Havana, Cuba.
FAU - Camacho-Freire, Santiago
AU  - Camacho-Freire S
AD  - Hospital Universitario Juan Ramon Jimenez, Huelva, Spain.
FAU - Manovel-Sanchez, Ana
AU  - Manovel-Sanchez A
AD  - Hospital Universitario Juan Ramon Jimenez, Huelva, Spain.
FAU - Naeem, Hesham
AU  - Naeem H
AD  - Rawalpindi Institute of Cardiology, Rawalpindi, Pakistan.
FAU - Fatima, Shazia
AU  - Fatima S
AD  - Nuclear Medicine, Oncology and Radiotherapy Institute (NORI), Islamabad, 
      Pakistan.
FAU - Rinaldi, Roberto
AU  - Rinaldi R
AD  - Health Physics Department, ASST-Spedali Civili, Brescia, Italy.
FAU - Carvajal-Juarez, Isabel
AU  - Carvajal-Juarez I
AD  - National Institute of Cardiology Ignacio Chavez, Mexico City, Mexico.
AD  - Hospital de Cardiologia Centro Medico Nacional Siglo XXI, Mexico City, Mexico.
FAU - Esenboga, Kerim
AU  - Esenboga K
AD  - Department of Cardiology, Medical School Ankara University, Ankara, Turkey.
FAU - Dondi, Maurizio
AU  - Dondi M
AD  - Nuclear Medicine and Diagnostic Imaging Section, Division of Human Health, 
      Department of Nuclear Sciences and Applications, International Atomic Energy 
      Agency, Vienna, Austria.
FAU - Paez, Diana
AU  - Paez D
AD  - Nuclear Medicine and Diagnostic Imaging Section, Division of Human Health, 
      Department of Nuclear Sciences and Applications, International Atomic Energy 
      Agency, Vienna, Austria.
LA  - eng
PT  - Equivalence Trial
PT  - Journal Article
PT  - Randomized Controlled Trial
DEP - 20221025
PL  - United States
TA  - J Nucl Cardiol
JT  - Journal of nuclear cardiology : official publication of the American Society of 
      Nuclear Cardiology
JID - 9423534
SB  - IM
MH  - Humans
MH  - Angioplasty
MH  - *Percutaneous Coronary Intervention
MH  - *ST Elevation Myocardial Infarction/therapy
MH  - Tomography, Emission-Computed, Single-Photon
MH  - Treatment Outcome
PMC - PMC9595582
OTO - NOTNLM
OT  - MPI
OT  - Myocardial ischemia and infarction
OT  - SPECT
COIS- The authors have indicated that they have no financial conflict of interest.
EDAT- 2022/10/26 06:00
MHDA- 2023/06/14 06:42
PMCR- 2022/10/25
CRDT- 2022/10/25 23:16
PHST- 2022/07/06 00:00 [received]
PHST- 2022/08/29 00:00 [accepted]
PHST- 2023/06/14 06:42 [medline]
PHST- 2022/10/26 06:00 [pubmed]
PHST- 2022/10/25 23:16 [entrez]
PHST- 2022/10/25 00:00 [pmc-release]
AID - S1071-3581(23)00021-1 [pii]
AID - 3108 [pii]
AID - 10.1007/s12350-022-03108-z [doi]
PST - ppublish
SO  - J Nucl Cardiol. 2023 Jun;30(3):1091-1102. doi: 10.1007/s12350-022-03108-z. Epub 
      2022 Oct 25.