Impact of bystander disease post PPCI to the culprit vessel post STEMI

• Research type

  Research Study

• Full title

  Impact of bystander disease after primary PCI to the culprit vessel after STEMI: prevalence of ischaemia and incidence of clinical events.

• IRAS ID

  173919

• Contact name

  Nicholas Peter Curzen

• Contact email

  nick.curzen@uhs.nhs.uk

• Sponsor organisation

  University Hospital Southampton NHS Foundation Trust

• Duration of Study in the UK

  0 years, 4 months, 1 days

• Research summary

  A STEMI (ST elevation myocardial infarction – heart attack), is the result of a blocked coronary artery. Current treatment is to re-open the blocked artery as soon as possible to restore blood flow to the heart muscle and minimise long term damage. STEMI patients undergo emergency primary percutaneous coronary intervention (PPCI), which usually means placement of a stent to the blocked artery. Some patients are found to have additional narrowings in other coronary arteries and it has been unclear how best to treat this “bystander disease”. Two randomised trials have recently reported a significant benefit to heart attack patients when all coronary narrowings are treated prior to discharge. As a result, some international guidelines have been altered to reflect the benefit of complete treatment of all narrowings.

  These data are discrepant with many sites' current practice, where the blocked coronary artery causing the heart attack is opened and bystander disease is initially left.

  Common practice is to treat the blocked vessel during the initial admission and discharge the patient. At routine follow-up symptoms are reassessed and testing offered as appropriate. Outpatient heart scan (stress magnetic resonance imaging -MRI) is commonly used. This encourages the treatment of significant narrowings only preventing unnecessary treatment of narrowings that don't restrict the blood flow which is associated with increased cost and clinical risk.

  The aim of this study is to assess the local outcome of patients presenting to UHS with STEMI and multivessel disease who have undergone PPCI for the heart attack artery alone and then progressed to further stent treatment on the basis of a positive stress MRI test.

  STEMI cases with multivessel disease will be identified from a local database according to national criteria.

  Data collected will include:
  • Demographics
  • Disease/treatment
  • MRI result
  • status at 12months
  • angina
  • management
  • coronary artery stenting or surgical bypass grafting
  • clinical events

• REC name

  West Midlands - Coventry & Warwickshire Research Ethics Committee

• REC reference

  15/WM/0160

• Date of REC Opinion

  30 Nov 2015

• REC opinion

  Further Information Favourable Opinion