6/29/23, 1:41 AM PRAMI Pathway Feedback Search Clinical Topics Home Studies PRAMI PRAMI Disease Disease Coronary artery disease ST-elevation myocardial infarction Trial question What is the role of preventive PCI in patients with acute STEMI and multivessel coronary artery disease? Study design Multi-center Open label RCT Population Characteristics of study participants 22.0% female N = 465 78.0% male 465 patients (102 female, 363 male) Inclusion criteria: acute STEMI (including 3 patients with left bundle-branch block) and multivessel coronary artery disease detected at the time of emergency infarct artery PCI Key exclusion criteria: cardiogenic shock, previous CABG, a noninfarct artery stenosis 50% in the left main stem or the ostia of both the left anterior descending and circumflex arteries, or if the only noninfarct stenosis was a chronic total occlusion Interventions N=234 preventive PCI (immediate preventive PCI in noninfarct arteries with > 50% stenoses) N=231 no preventive PCI (no further PCI procedures) https://web.pathway.md/studies/recv4HPpLFNU1bc2P 1/2 6/29/23, 1:41 AM PRAMI Pathway Primary outcome Death from cardiac causes, nonfatal myocardial infarction, or refractory angina 23.0 % 23 17.3 % 11.5 % 9 Significant decrease 5.8 % NNT = 7 0.0 % Preventive PCI No preventive percutaneous coronary intervention Significant decrease in death from cardiac causes, nonfatal myocardial infarction, or refractory angina (9% vs. 23%; HR 0.35, 95% CI 0.21 to 0.58) Secondary outcomes No significant difference in cardiovascular death (4 vs. 10; HR 0.34, 95% CI 0.11 to 1.08) Significant decrease in nonfatal myocardial infarction (7 vs. 20; HR 0.32, 95% CI 0.13 to 0.75) Significant decrease in refractory angina (12 vs. 30; HR 0.35, 95% CI 0.18 to 0.69) Conclusion In acute STEMI (including 3 patients with left bundle-branch block) and multivessel coronary artery disease detected at the time of emergency infarct artery PCI, preventive PCI was superior to no preventive PCI with respect to death from cardiac causes, nonfatal myocardial infarction, or refractory angina. Reference Wald DS, Morris JK, Wald NJ et al. Randomized trial of preventive angioplasty in myocardial infarction. N Engl J Med. 2013 Sep 19;369(12):1115-23. Open reference URL https://web.pathway.md/studies/recv4HPpLFNU1bc2P 2/2