RT Journal Article SR Electronic T1 Ischemia-guided vs routine non-culprit vessel percutaneous coronary intervention for patients with multi-vessel disease presenting with ST segment elevation myocardial infarction: the IAEA SPECT STEMI trial JF Journal of Nuclear Medicine JO J Nucl Med FD Society of Nuclear Medicine SP P381 OP P381 VO 64 IS supplement 1 A1 Giammarile, Francesco A1 Karthikeyan, Ganesan A1 Peix, Amalia A1 Devasenapathy, Niveditha A1 Jimenez-Heffernan, Amelia A1 Haque, Saif A1 Rodella, Carlo Alberto A1 Giubbini, Raffaele A1 Alexanderson Rosas, Erick A1 Ozkan, Elgin A1 Keng, Felix A1 Vitola, João A1 Sobic-Saranovic, Dragana A1 Soni, Manoj A1 López, Leonardo A1 Cabrera, Lázaro A1 Camacho-Freire, Santiago A1 Manovel-Sanchez, Ana A1 Naeem, Hesham A1 Fatima, Shazia A1 Rinaldi, Roberto A1 Carvajal, Isabel A1 Esenboga, Kerim A1 Dondi, Maurizio A1 Paez, Diana YR 2023 UL http://jnm.snmjournals.org/content/64/supplement_1/P381.abstract AB P381 Introduction: Efficacy and safety of ischemia-guided vs routine non-culprit vessel percutaneous coronary intervention (PCI) has not been adequately studied in patients with multi-vessel disease presenting with ST elevation myocardial infarction (STEMI).Methods: An international, randomized, non-inferiority trial comparing ischemia-guided non-culprit vessel angioplasty to routine non-culprit vessel PCI, following primary PCI for STEMI was conducted in nine countries, sponsored by the International Atomic Energy Agency (IAEA). The primary outcome was the between-group difference in percent ischemic myocardium at follow-up stress SPECT myocardial perfusion imaging (MPI). All MPI images were processed and analyzed at a central core lab, blinded to treatment allocation.Results: In all, 109 patients were included. In the ischemia-guided arm, 25/48 (47%) patients underwent non-culprit vessel PCI following stress MPI, while in the routine non-culprit PCI arm, 43/56 (77%) patients underwent PCI. The median percentage of ischemic myocardium on follow-up imaging (mean 16.5 months) was low, and identical (2.9%) in both arms (difference 0.13%, 95%CI 2 1.3%–1.6%, P < .0001; non-inferiority margin 5%).Conclusions: A strategy of ischemia-guided non-culprit PCI resulted in low ischemia burden, being non-inferior to a strategy of routine non-culprit vessel PCI. In addition, a selective non-culprit PCI following STEMI offers the potential for cost-savings, and may be particularly relevant to low-and-middle income countries, where appropriate allocation of resources is critical.