PROMPT: Peri-Infarct Zone Pacing Does Not Prevent Adverse LV Remodeling in MI Patients

Peri-infarct pacing did not prevent left ventricular (LV) remodeling or improve functional, or clinical outcomes during 18 months of follow-up in patients with large first myocardial infarction (MI), according to results from the PROMPT Trial presented Aug. 30 during ESC Congress 2015 in London and simultaneously published in the European Heart Journal.

The study, conducted between December 2010 and October 2013, randomized 126 patients at 27 sites in Europe, the Middle East and the U.S. to LV and right ventricular pacing, LV pacing only and no implant. The primary endpoint was change in LV end-diastolic volume (LVEDV) in the echocardiographic apical 4-chamber view from baseline to 18 months between the pooled pacing therapy groups and the control group.

Results from the study showed no significant difference between the pooled pacing groups and control group in the primary endpoint. LVEDV increased by 15.3 mL in the control group and 16.7 mL in the pacing groups during follow-up (p=0.92). There were also no significant differences between the groups in the change in LVEDV or ejection fraction over time.

According to lead investigator Gregg W. Stone, MD, FACC, the neutral effects of pacing were also reflected in similar outcomes between groups in quality of life measures and exercise performance, as well as mortality and heart failure hospitalization outcomes.

"The results of this trial are sufficiently neutral such that future studies will most likely not explore peri-infarct LV pacing to improve outcomes for patients with large MI," says Stone. "Other strategies are desperately needed to improve the prognosis for these high-risk patients, and numerous pharmacologic and device-based approaches are being studied for this purpose."

Clinical Topics: Heart Failure and Cardiomyopathies

Keywords: Myocardial Infarction, Ventricular Remodeling, ESC Congress

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