Abstract
Conflicting data is present in the literature about patients who are treated with percutaneous coronary intervention (PCI) due to the exaggeration of the non culprit artery. The precise understanding of the non culprit artery in the setting of ST segment elevated myocardial infarct (STEMI) is important since the time and modality of the treatment is planned accordingly. The aim of this study is to evaluate the lesions in the non culprit coronary artery during primary PCI and control coronary angiography (CAG) using quantitative coronary angiography (QCA) in multivessel STEMI patients. In this study, multivessel disease STEMI patients whom underwent primary PCI between January 2010 and March 2011 were included. Critical stenosis degree was accepted as ≥70 % in the non culprit artery. All patients were evaluated with control CAG 1 month after primary PCI. Assessment with CAG was performed by two blinded cardiologists. QCA program was used to evaluate reference artery diameter (RAD), minimum luminal diameter (MLD) and degree of stenosis. With regard to the degree of stenosis, significant reduction was accepted as ≥15 % while % 5–15 decrease was accepted as moderate. Of the 81 patients, 61 were males and 20 were females (mean age 58.1 ± 10). In the control CAG, the degree of non culprit artery stenosis was found to be decreased (p < 0.001) while RAD and MLD were increased (p < 0.001 and p < 0.001 respectively). Significant decrease in critical non culprit artery lesions was detected in 22 patients (20.9 %) meanwhile moderate reduction was observed in 26 patients (24.7 %). In 14 patients (13.3 %), non culprit artery lesions accepted as critical during primary PCI were found to be non critical during the control CAG. Planned intervention was cancelled and medical treatment was initiated in those 14 patients. Our data indicated using QCA, approximately the half of non culprit lesions were found less critical during control CAG when compared to primary PCI. Therefore, it is concluded that complete revascularization during primary PCI should be avoided in multivessel STEMI patients and critical non culprit artery lesions should be re-evaluated with later control CAG.
Similar content being viewed by others
References
Boersma E, Mercado N, Poldermans D, Gardien M, Vos J, Simoons ML (2003) Acute myocardial infarction. Lancet 361(9360):847–858. doi:10.1016/S0140-6736(03)12712-2
Rodriguez-Granillo GA, Garcia-Garcia HM, Valgimigli M, Vaina S, van Mieghem C, van Geuns RJ, van der Ent M, Regar E, de Jaegere P, van der Giessen W, de Feyter P, Serruys PW (2006) Global characterization of coronary plaque rupture phenotype using three-vessel intravascular ultrasound radiofrequency data analysis. Eur Heart J 27(16):1921–1927. doi:10.1093/eurheartj/ehl104
Hansson GK (2005) Inflammation, atherosclerosis, and coronary artery disease. N Engl J Med 352(16):1685–1695. doi:10.1056/NEJMra043430
Nallamothu B, Fox KA, Kennelly BM, Van de Werf F, Gore JM, Steg PG, Granger CB, Dabbous OH, Kline-Rogers E, Eagle KA, Investigators G (2007) Relationship of treatment delays and mortality in patients undergoing fibrinolysis and primary percutaneous coronary intervention. The global registry of acute coronary events. Heart 93(12):1552–1555. doi:10.1136/hrt.2006.112847
Jaski BE, Cohen JD, Trausch J, Marsh DG, Bail GR, Overlie PA, Skowronski EW, Smith SC Jr (1992) Outcome of urgent percutaneous transluminal coronary angioplasty in acute myocardial infarction: comparison of single-vessel versus multivessel coronary artery disease. Am Heart J 124(6):1427–1433
Sorajja P, Gersh BJ, Cox DA, McLaughlin MG, Zimetbaum P, Costantini C, Stuckey T, Tcheng JE, Mehran R, Lansky AJ, Grines CL, Stone GW (2007) Impact of multivessel disease on reperfusion success and clinical outcomes in patients undergoing primary percutaneous coronary intervention for acute myocardial infarction. Art J 28 (14):1709–1716. doi:10.1093/eurheartj/ehm184
Hanratty CG, Koyama Y, Rasmussen HH, Nelson GI, Hansen PS, Ward MR (2002) Exaggeration of nonculprit stenosis severity during acute myocardial infarction: implications for immediate multivessel revascularization. J Am Coll Cardiol 40(5):911–916
Gibson CM, Ryan KA, Murphy SA, Mesley R, Marble SJ, Giugliano RP, Cannon CP, Antman EM, Braunwald E (1999) Impaired coronary blood flow in nonculprit arteries in the setting of acute myocardial infarction. The TIMI study group. Thrombolysis in myocardial infarction. J Am Coll Cardiol 34(4):974–982
Stewart DJ, Kubac G, Costello KB, Cernacek P (1991) Increased plasma endothelin-1 in the early hours of acute myocardial infarction. J Am Coll Cardiol 18(1):38–43
Reilly MP, Delanty N, Roy L, Rokach J, Callaghan PO, Crean P, Lawson JA, FitzGerald GA (1997) Increased formation of the isoprostanes IPF2alpha-I and 8-epi-prostaglandin F2alpha in acute coronary angioplasty: evidence for oxidant stress during coronary reperfusion in humans. Circulation 96(10):3314–3320
Gregorini L, Marco J, Kozakova M, Palombo C, Anguissola GB, Marco I, Bernies M, Cassagneau B, Distante A, Bossi IM, Fajadet J, Heusch G (1999) Alpha-adrenergic blockade improves recovery of myocardial perfusion and function after coronary stenting in patients with acute myocardial infarction. Circulation 99(4):482–490
Scanlon PJ, Faxon DP, Audet AM, Carabello B, Dehmer GJ, Eagle KA, Legako RD, Leon DF, Murray JA, Nissen SE, Pepine CJ, Watson RM, Ritchie JL, Gibbons RJ, Cheitlin MD, Gardner TJ, Garson A Jr, Russell RO Jr, Ryan TJ, Smith SC Jr (1999) ACC/AHA guidelines for coronary angiography: executive summary and recommendations. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Coronary Angiography) developed in collaboration with the Society for Cardiac Angiography and Interventions. Circulation 99(17):2345–2357
Lee SG, Lee CW, Hong MK, Kim JJ, Park SW, Park SJ (2004) Change of multiple complex coronary plaques in patients with acute myocardial infarction: a study with coronary angiography. Am Heart J 147(2):281–286. doi:10.1016/j.ahj.2003.09.012
Kahn JK, Rutherford BD, McConahay DR, Johnson WL, Giorgi LV, Shimshak TM, Ligon R, Hartzler GO (1990) Results of primary angioplasty for acute myocardial infarction in patients with multivessel coronary artery disease. J Am Coll Cardiol 16(5):1089–1096
Goldstein JA, Demetriou D, Grines CL, Pica M, Shoukfeh M, O’Neill WW (2000) Multiple complex coronary plaques in patients with acute myocardial infarction. N Engl J Med 343(13):915–922. doi:10.1056/NEJM200009283431303
Qarawani D, Nahir M, Abboud M, Hazanov Y, Hasin Y (2008) Culprit only versus complete coronary revascularization during primary PCI. Int J Cardiol 123(3):288–292. doi:10.1016/j.ijcard.2006.12.013
Toma M, Buller CE, Westerhout CM, Fu Y, O’Neill WW, Holmes DR Jr, Hamm CW, Granger CB, Armstrong PW, Investigators A-A (2010) Non-culprit coronary artery percutaneous coronary intervention during acute ST-segment elevation myocardial infarction: insights from the APEX-AMI trial. Eur Heart J 31(14):1701–1707. doi:10.1093/eurheartj/ehq129
Vlaar PJ, Mahmoud KD, Holmes DR Jr, van Valkenhoef G, Hillege HL, van der Horst IC, Zijlstra F, de Smet BJ (2011) Culprit vessel only versus multivessel and staged percutaneous coronary intervention for multivessel disease in patients presenting with ST-segment elevation myocardial infarction: a pairwise and network meta-analysis. J Am Coll Cardiol 58(7):692–703. doi:10.1016/j.jacc.2011.03.046
Hochman JS, Sleeper LA, Webb JG, Sanborn TA, White HD, Talley JD, Buller CE, Jacobs AK, Slater JN, Col J, McKinlay SM, LeJemtel TH (1999) Early revascularization in acute myocardial infarction complicated by cardiogenic shock. SHOCK investigators. Should we emergently revascularize occluded coronaries for cardiogenic shock. N Engl J Med 341(9):625–634. doi:10.1056/NEJM199908263410901
Garcia S, Sandoval Y, Roukoz H, Adabag S, Canoniero M, Yannopoulos D, Brilakis ES (2013) Outcomes after complete versus incomplete revascularization of patients with multivessel coronary artery disease: a meta-analysis of 89,883 patients enrolled in randomized clinical trials and observational studies. J Am Coll Cardiol 62(16):1421–1431. doi:10.1016/j.jacc.2013.05.033
Jeger R, Jaguszewski M, Nallamothu BN, Luscher TF, Urban P, Pedrazzini GB, Erne P, Radovanovic D, Investigators AP (2014) Acute multivessel revascularization improves 1-year outcome in ST-elevation myocardial infarction: a nationwide study cohort from the AMIS Plus registry. Int J Cardiol 172 (1):76–81. doi:10.1016/j.ijcard.2013.12.083
Dziewierz A, Siudak Z, Rakowski T, Zasada W, Dubiel JS, Dudek D (2010) Impact of multivessel coronary artery disease and noninfarct-related artery revascularization on outcome of patients with ST-elevation myocardial infarction transferred for primary percutaneous coronary intervention (from the EUROTRANSFER Registry). Am J Cardiol 106(3):342–347. doi:10.1016/j.amjcard.2010.03.029
Kornowski R, Mehran R, Dangas G, Nikolsky E, Assali A, Claessen BE, Gersh BJ, Wong SC, Witzenbichler B, Guagliumi G, Dudek D, Fahy M, Lansky AJ, Stone GW, Investigators H-AT (2011) Prognostic impact of staged versus “one-time” multivessel percutaneous intervention in acute myocardial infarction: analysis from the HORIZONS-AMI (harmonizing outcomes with revascularization and stents in acute myocardial infarction) trial. J Am Coll Cardiol 58(7):704–711. doi:10.1016/j.jacc.2011.02.071
Parodi G, Memisha G, Valenti R, Trapani M, Migliorini A, Santoro GM, Antoniucci D (2005) Five year outcome after primary coronary intervention for acute ST elevation myocardial infarction: results from a single centre experience. Heart 91(12):1541–1544. doi:10.1136/hrt.2004.054692
Kim DH, Burton JR, Fu Y, Lindholm L, Van de Werf F, Armstrong PW; for the CAPTORS II Investigators (2006) What is the frequency and functional and clinical significance of complex lesions in non-infarct-related arteries after fibrinolysis for acute ST-elevation myocardial infarction? Am Heart J 151(3):668–673
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
All authors declare that they have no conflicts of interest.
Ethical standard
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent
Informed consent was obtained from all individual participants included in the study.
Rights and permissions
About this article
Cite this article
Dönmez, E., Koç, M., Şeker, T. et al. The assessment of non culprit coronary artery lesions in patients with ST segment elevated myocardial infarction and multivessel disease by control angiography with quantitative coronary angiography. Int J Cardiovasc Imaging 32, 1471–1476 (2016). https://doi.org/10.1007/s10554-016-0943-8
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10554-016-0943-8