MULTivessel Immediate Versus STAged RevaScularization in Acute Myocardial Infarction -The MULTISTARS AMI Trial
- Conditions
- Multivessel Coronary DiseaseST-elevation Myocardial Infarction
- Interventions
- Procedure: Immediate complete PCIProcedure: Staged complete PCIDevice: Synergy™ stent
- Registration Number
- NCT03135275
- Lead Sponsor
- University of Zurich
- Brief Summary
The primary objective of the trial is to compare, in patients presenting with ST segment elevation myocardial infarction (STEMI) and multi-vessel disease (MVD), the safety and efficacy of immediate complete revascularization of all significant coronary lesions versus culprit vessel only revascularization and staged percutaneous coronary intervention (PCI) of all significant coronary lesions (within 19 to 45 days), in a non-inferiority trial using a third generation, biodegradable-polymer, everolimus-eluting stent.
- Detailed Description
An investigator-initiated, randomized, multicenter, two-arm, open-label study of consecutive patients presenting with STEMI and MVD in stable hemodynamic conditions, undergoing after successful PCI of the culprit lesion either (1:1 randomization) immediate revascularization of all additional target lesions during the index procedure or staged PCI of all additional target lesions (within 19 to 45 days) using the Boston Scientific Synergy™ stent.
The goal of this trial is to compare two treatment strategies that are currently performed in clinical practice: immediate complete revascularization versus staged complete revascularization in patients with STEMI and MVD.
Patients randomized to immediate complete revascularization will have treated during the index procedure, after revascularization of the culprit lesion, all significant non-culprit coronary lesions.
Patients randomized to staged complete revascularization will have treated during the index procedure only the culprit lesion, and they will be hospitalized after 19-45 days for complete revascularization of all significant non-culprit coronary lesions.
For both groups, lesion are considered significant when causing a ≥70% diameter stenosis by visual estimation in at least two projections on the coronary angiogram.
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 840
- Age ≥ 18 years
- Spontaneous acute STEMI (patients presenting within 24 hours of symptom onset)
- Suitability for PCI from femoral or radial access
- Coronary anatomy suitable for complete coronary revascularization with Synergy® stent implantation
- Identifiable culprit lesion/artery
- At least one non-culprit coronary stenosis ≥ 70% in at least two projections, in a vessel with a lumen diameter ≥2.25 - ≤5.75 mm, other than the culprit artery
- TIMI Flow 3 or TIMI flow 2 after revascularization of the culprit artery
- Stable hemodynamics at the end of the culprit vessel revascularization
- Inability to give informed consent
- Cardiogenic shock
- Prolonged resuscitation >10 min
- General unsuitability for PCI
- Need for emergency CABG
- Previous CABG
- Planned hybrid revascularization
- Coronary artery dissection
- STEMI due to ST
- Previous documented allergic reaction to everolimus or to any stent material
- Severe mechanical complication of acute myocardial infarction
- Pre-existing severe renal failure (eGFR <30 mL/min) or renal replacement therapy
- Chronic total occlusion of a major coronary artery
- Left main stem stenosis ≥50% or left main stem equivalent (ostial left anterior descending and ostial circumflex stenosis ≥70%)
- In-stent restenosis
- Panned coronary, cerebrovascular, or peripheral arterial revascularization
- Planned cardiac or major surgery
- Any contraindications for dual antiplatelet therapy with aspirin and a P2Y12 Inhibitor for at least 90 days, except for patients on oral anticoagulation
- Known pregnancy at the time of inclusion
- Participation in another clinical study with an investigational product
- Life expectancy <1 year
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Immediate complete PCI Immediate complete PCI Patients randomized to immediate complete PCI will have treated immediately after the revascularization of the culprit lesion during the index procedure all the other significant coronary lesions. All the revascularizations will be performed with Synergy™ stent. Staged complete PCI Staged complete PCI Patients randomized to staged complete PCI will have treated during the index admission only the culprit lesion and they will be hospitalized after 19-45 days, to complete the coronary revascularization on all the other significant coronary lesions. All the revascularizations will be performed with Synergy™ stent. Staged complete PCI Synergy™ stent Patients randomized to staged complete PCI will have treated during the index admission only the culprit lesion and they will be hospitalized after 19-45 days, to complete the coronary revascularization on all the other significant coronary lesions. All the revascularizations will be performed with Synergy™ stent. Immediate complete PCI Synergy™ stent Patients randomized to immediate complete PCI will have treated immediately after the revascularization of the culprit lesion during the index procedure all the other significant coronary lesions. All the revascularizations will be performed with Synergy™ stent.
- Primary Outcome Measures
Name Time Method The primary outcome measure is a composite of all-cause death, non-fatal myocardial infarction, unplanned ischemia-driven revascularization, hospitalization for heart failure, and stroke at 1 year 1-year
- Secondary Outcome Measures
Name Time Method All-cause death 6 months, 1 year Single components of the primary endpoint
Target vessel revascularization (TVR) 6 months, 1 year Non-fatal myocardial infarction 6 months, 1 year Single components of the primary endpoint
Target lesion revascularization (TLR) 6 months, 1 year All-cause death, non-fatal myocardial infarction, unplanned ischemia-driven revascularization, hospitalization for heart failure, and stroke 6 months Primary endpoint
Hospitalization for heart failure 6 months, 1 year Single components of the primary endpoint
Cardiac death 6 months, 1 year Unplanned ischemia-driven revascularization 6 months, 1 year Single components of the primary endpoint
Stroke 6 months, 1 year Single components of the primary endpoint
Quality of life (EQ-5D questionnaire) 6 months, 1 year Non-cardiovascular death 6 months, 1 year Cardiovascular death 6 months, 1 year Cardiac death or myocardial infarction 6 months, 1 year Acute renal insufficiency or dialysis 6 months, 1 year Procedural success 6 months, 1 year Bleeding event (BARC definition) 6 months, 1 year All-cause death or myocardial infarction 6 months, 1 year Stent thrombosis 6 months, 1 year
Trial Locations
- Locations (1)
University Hospital Zürich, Cardiology Department
🇨🇭Zurich, Switzerland