Complete Infarct Related Artery Revascularization in Acute Myocardial Infarction

Study Overview
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Brief Summary
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Objective of this registry study is to compare strategy of complete vs. target lesion-only primary PCI (percutaneous coronary intervention) in IRA (infarct related artery) in STEMI (ST elevation myocardial infarction) patients.

Detailed Description
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CORAMI is a registry study addressing the issue of complete vs culprit-only PCI within infarct related artery in patients with ST-elevation and non-ST elevation myocardial infarction treated with interventional procedures. The main objectives of the study include: gathering data on patients with at least two independent critical stenotic lesions in IRA (one of which is the culprit lesion) during index primary PCI for STEMI or NSTEMI (prevalence, characteristic, predisposing factors). comparing chosen treatment strategies for multiple lesion IRA comparison of complete vs. target lesion-only PCI in IRA in acute MI (myocardial infarction) patients. The study clinical hypothesis is that stenting single critical - culprit lesion in multi-lesion IRA in MI patients during index PCI procedure is superior to stenting all critical lesions in IRA in terms of early treatment result and might be associated with less frequent periprocedural angiographic complications. H0: The efficacy in terms of early treatment result of stenting one critical - culprit lesion in multilesions IRA in acute MI patients is less or equal to efficacy of stenting all critical lesions in IRA. H1: The efficacy in terms of early treatment result of stenting one critical - culprit lesion in multilesions IRA in acute MI patients is greater than efficacy of stenting all critical lesions in IRA. CORAMI Registry is a prospective, international (Poland, Slovenia), multicenter observational study with retrospective chart review which will be performed in experienced invasive facility centres with 24/7 PCI duty and continuous patient enrollment for 18 months (January 2011 - June 2012). This study will collect data on all consecutive patients with STEMI and NSTEMI undergoing immediate coronary angiography which demonstrated at least two independent (requiring two stent platforms) critical lesions in infarct related artery (one of which is considered as target/culprit lesion that have caused the myocardial infarction and requires immediate PCI). Patients will be treated (multiple or single lesion stenting) according to local standard and operator's decision. Patient follow up phone call and/or visit (according to local protocols) will be performed at 12 months from enrollment if applicable by local standards.

Official Title
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Complete Infarct Related Artery Revascularization in Acute Myocardial Infarction Registry(CORAMIreg)

Conditions
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Myocardial Infarction

Intervention / Treatment
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* Device: Primary PCI of culprit lesion in IRA with drug eluting stent (DES)
* Device: Primary PCI of culprit lesion in IRA with drug eluting stent (DES) and PCI of the other critical lesion in IRA with another DES


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Diagnosis of STEMI or NSTEMI (according to ESC 2007 definition) Over 18 years of age Presence of two critical lesions requiring PCI in IRA (LAD (left anterior descending), Cx (circumflex), RCA (right coronary artery)): Target/culprit lesion which requires immediate stenting (>50 - 100%) and Second critical lesion (70-90%). Exclusion Criteria: Terminal illness with life expectancy less <1 year or active cancer disease, Pregnancy or possibility of pregnancy Second critical lesion in IRA >90% or occlusion Contraindications to PCI or/and stent implantation Con-current participation in another clinical study that did not meet its primary end-point

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Culprit lesion IRA revascularization<br>Culprit lesion IRA revascularization | Device: Primary PCI of culprit lesion in IRA with drug eluting stent (DES)<br>* Primary PCI of culprit lesion in IRA with drug eluting stent (DES)<br>|
| Complete IRA revascularization<br>Complete IRA revascularization | Device: Primary PCI of culprit lesion in IRA with drug eluting stent (DES) and PCI of the other critical lesion in IRA with another DES<br>* Primary PCI of culprit lesion in IRA with drug eluting stent (DES) and PCI of the other critical lesion in IRA with another DES<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Death | Death rates at 12-month clinical follow-up | At 12 months | 
| Stent thrombosis | Rates of stent thrombosis at 12-month follow-up according to ARC definition | At 12 months | 
| reMI (repeat myocardial infarctions) | Rates of reMI at 12 months | At 12 months | 
| urgent TVR (target vessel revascularization) at 12 months | Rates of urgent TVR at 12 months | 12 months and at 12 months | 
| Planned TVR | Rates of planned TVR (PCI + CABG) at 12 months | At 12 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Angiographic complications | Immediate in-hospital angiographic complications (at least one or more of the following: distal embolisation, no-reflow, slow-flow, acute coronary artery occlusion, artery perforation, tamponade, dissection type B and above) | During hospitalization | 
| Target Vessel Revascularization (PCI and/or CABG (coronary artery bypass graft)) | Urgent in-hospital Target Vessel Revascularization (PCI and/or CABG) | During hospitalization and at 12 months | 
| Complete contrast dose in ml | Complete contrast dose in ml | During hospitalization and at 12 months | 
| Complete radiation dose in mGy | Complete radiation dose in mGy | During hospitalization and at 12 months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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STEMI, NSTEMI, revascularization, stents