CvLPRIT: Complete Versus Lesion-only PRimary PCI PiloT Study
Principal Investigator: Professor Tony Gershlick
There are over 100,000 cases per year in the UK of ST-segment elevation myocardial infarction (STEMI). STEMI is caused by a blockage of one of the three main coronary arteries. Treatment involves emergency coronary angioplasty (the removal of the offending clot, stretching of the narrowed artery using a ‘balloon,’ and implantation of a stent – a mini scaffold).
The blocked artery causing the STEMI is known as the ‘culprit’ artery. However, in up to half of all cases, there is also significant narrowing in the other arteries (known as non-infarct related arteries) causing multi-vessel disease.
Current guidelines recommend that in multi-vessel disease, only the ‘culprit’ artery should be treated during emergency coronary angioplasty (culprit lesion-only revascularisation). Any significantly narrowed non-infarct related arteries should be treated as an outpatient if required. However, these guidelines are based on retrospective studies and a small number of randomised controlled trials (RCTs) comparing culprit-lesion only revascularisation against the treatment of all affected arteries (complete revascularisation). There is a pressing need for larger studies providing a greater understanding of the effects of treatment on the heart’s structure and function through more sophisticated imaging of the heart.
The CvLPRIT study – a large multicentre (7 centres within the UK) trial funded by the British Heart Foundation – is the largest RCT comparing culprit-lesion only versus complete revascularisation to date (n=285) and the only study of its kind assessing the heart using Cardiac Magnetic Resonance Imaging (MRI).
Cardiac Magnetic Resonance Imaging (CMR) sub-study
Principal Investigator: Dr Gerry McCann
The NIHR-funded Cardiac MRI sub-study (n=200) will use the ‘gold standard’ imaging method to study the heart’s pumping function and will measure damage (scarring, oedema, destruction of the small blood vessels feeding the heart muscle) sustained at the time of the heart attack and at 9-months follow up, when the heart has had time to heal. The importance of CvLPRIT is illustrated by its inclusion in the current European Society of Cardiology STEMI management guidelines as a key study in progress.