Non-culprit coronary artery percutaneous coronary intervention during acute ST-segment elevation myocardial infarction: insights from the APEX-AMI trial

Abstract

Non-culprit coronary interventions were performed at the time of primary PCI in 10% of MVD patients and were significantly associated with increased mortality. Our data support current guideline recommendations discouraging the performance of such procedures in stable primary PCI patients. Prospective randomized study of this issue may be warranted.

Assisted Beating of the Ischemic Heart

“…The HORIZONS-AMI showed a quadrupled 1-year mortality when multivessel PCI was the primary intervention; nonetheless, 18.5% of the patients received multivessel PCI with only 1.5% experiencing cardiogenic shock. 27 The Assessment of Pexelizumab in Acute Myocardial Infarction (APEX-AMI) trial indicated an increased 90-day mortality when nonculprit interventions were performed at the time of primary PCI, 28 and Hannan et al further corroborated the current guideline recommendations via lower in-hospital mortality. However, staged multivessel PCI within 60 days after the initial intervention led to a significantly reduced 1-year mortality, 29 and a more aggressive interventional strategy immediately targeting all angiographic lesions has been advocated by the Preventative Angioplasty in Myocardial Infarction (PRAMI) trial.…”

Complete Revascularization versus Culprit- Vessel Revascularization in Acute Myocardial Infarction: Six Months Follow-up

“…This finding suggests that a significant proportion of these patients have an increased risk of death and adverse outcomes even after receiving reperfusion therapy through thrombolysis or p-PCI for infarct-related artery (IRA) [12]. However, the prognostic impact of revascularization for non-IRA in patients with MVD after p-PCI on clinical outcomes has not been fully investigated [12,[15][16][17][18].…”

Coronary air embolism during coronary angiography: reminder of a potentially lethal but avoidable complication

“…Earlier results of trials comparing MPS and CO approaches were controversial [12][13][14][15][16][17][18][19], probably due to the heterogeneity of patient samples, variable endpoints, distinct inclusion criteria and different study protocols. European and American Cardiology Societies for 2010-2013 [1][2][3] recommended limiting PPCI to the vessel with a culprit stenosis with the exception of cardiogenic shock and persistent ischaemia after PCI.…”