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According to the results of the PRAMI trial
patients with STEMI who undergo a preventive procedure
to unblock additional coronary artery have significantly better outcomes
462 patients with STEMI
and multi-vessel disease were randomized in PRAMI
to infarct artery PCI alone or additional preventive PCI
The results of this trial show that, in this setting,
preventive PCI reduces the risk of cardiac death,
subsequent myocardial infarction or refractory angina
by 65 %
The TASTE trial is the first large-scale randomized trial of thrombus aspiration
for STEMI
Using a novel registry based concept, the study included
7,244 Swedish STEMI patients randomized to PCI with or without
thrombo-aspiration
The primary endpoint was all cause death at 30 days and the main result
for this endpoint was that 2.8 % of patients have died
in the thrombus aspiration group and 3 % in the PCI alone group
We did a trial to look at one of the very important stages in primary PCI
thrombus aspiration, does this part of PCI save lifes?
our answer is very definitive, no it does not
ACCOAST is a randomized double blind study that evaluated for the first time
pre-treatment in patients presenting with non-ST elevation ACS
and invasively managed, they had to go to the cathlab
within 48 hours and preferably within 24 hours
This study randomized 4,333 patients to receive
either pre-treatment with prasugrel 30 mg
or placebo at the time of non ST
acute coronary syndrome diagnostic
There was no benefit of pre-treatment, absolutely no hint
of benefit on ischemic endpoint, there was an excess of bleeding
which was significant
There was a 2 fold increase in major bleeding in these patients
Clearly the risk/benefit ratio is in favor of
having the drug in the cathlab, when the coronary anatomy has been defined
and when we are sure that PCI is needed
and not to give the drug systematically to the patient before they get to the cathlab
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