Non-culprit lesions detected during primary PCI: treat invasively or follow the guidelines?

Jh, Dambrink; Jp, Debrauwere; Aw, van Toorenenbergen; Ottervanger, J. P.; At, Gosselink; Jc, Hoorntje; Mj, de Boer; Suryapranata, Harry

doi:10.4244/eijv5i8a162

Cited by 80 publications

(51 citation statements)

References 20 publications

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“…In the present study we also observed that most MACE occurred during the first 6 months of follow-up (Table 5). This is in line with our previous conclusion that an early ischaemia-guided additional revascularisation prevents later PCI procedures but does not result in a reduction of total MACE [7].…”

Section: Discussionsupporting

confidence: 81%

“…Previously we reported that FFR-guided early additional revascularisation resulted in more death and MI compared with culprit-only revascularisation (14 vs 0 %, p00.015) and found no difference in MACE between the invasive and conservative group (21 vs 22 %, p00.93) at 6-months follow-up [7]. In the present study we demonstrated that FFR-guided early additional revascularisation (invasive approach) reduced the number of non-culprit related PCI procedures after discharge compared with the conservative strategy.…”

Section: Discussionmentioning

confidence: 99%

“…Previously we reported the results of the primary endpoint [7]. Three-year follow-up was available in 119 of 121 patients.…”

Section: Outcomementioning

confidence: 99%

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Treatment of non-culprit lesions detected during primary PCI: long-term follow-up of a randomised clinical trial

et al. 2012

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Background There are conflicting data regarding optimal treatment of non-culprit lesions detected during primary percutaneous coronary intervention (PCI) in patients with ST-elevation myocardial infarction (STEMI) and multivessel disease (MVD). We aimed to investigate whether ischaemia-driven early invasive treatment improves the long-term outcome and prevents major adverse cardiac events (MACE). Methods 121 patients with at least one non-culprit lesion were randomised in a 2:1 manner, 80 were randomised to early fractional flow reserve (FFR)-guided PCI (invasive group), and 41 to medical treatment (conservative group). The primary endpoint was MACE at 3 years.Results Three-year follow-up was available in 119 patients (98.3 %). There was no significant difference in all-cause mortality between the invasive and conservative strategy, 4 patients (3.4 %) died, all in the invasive group (P00.29). Re-infarction occurred in 14 patients (11.8 %) in the invasive group versus none in the conservative group (p00.002). Re-PCI was performed in 7 patients (8.9 %) in the invasive group and in 13 patients (32.5 %) in the conservative group (P00.001). There was no difference in MACE between these two strategies (35.4 vs 35.0 %, p00.96). Conclusions In STEMI patients with MVD, early FFRguided additional revascularisation of the non-culprit lesion did not reduce MACE at three-year follow-up compared with a more conservative strategy. The rate of MACE in the invasive group was predominantly driven by death and re-infarction, whereas in the conservative group the rate of MACE was only driven by repeat interventions.

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Section: Discussionsupporting

confidence: 81%

Section: Discussionmentioning

confidence: 99%

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Treatment of non-culprit lesions detected during primary PCI: long-term follow-up of a randomised clinical trial

et al. 2012

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“…Пациенты с ИМпST, имеющие многососудистое поражение (МП) коронарного русла, характеризуются большим риском неблаго-приятных кардиоваскулярных событий в ближай-шем и отдаленном периоде наблюдения, несмотря на выполнение им реваскуляризации миокарда в сравнении с больными, имеющими однососу-дистое поражение [4,5]. Такие пациенты требуют адекватной стратификации риска и поиска опти-мальных стратегий реваскуляризации.…”

Section: Introductionunclassified

Factors of Mortality in St-Elevation Myocardial Infarction Patients With Multivessel Coronary Disease After Endovascular Revascularization

Тарасов¹,

Ганюков²

2015

Kompleks. probl. serdečno-sosud. zabol.

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Федеральное государственное бюджетное научное учреждение «Научно-исследовательский институт комплексных проблем сердечно-сосудистых заболеваний», лаборатория интервенционных методов диагностики и лечения атеросклероза, Кемерово, РоссияЦель. Выявить клинико-демографические и анатомо-ангиографические факторы, связанные со смертельным исходом после первичного чрескожного коронарного вмешательства (ЧКВ) у пациентов с инфарктом миокарда с подъемом сегмента St (ИМпSt) и многососудистым поражением (МП) коронарного русла на протяжении 12 месяцев наблюдения.Материалы и методы. В исследование было включено 327 последовательных пациентов с ИМпSt, имеющих МП коронар-ного русла, получивших реваскуляризацию в первые 12 часов от начала заболевания посредством первичного ЧКВ. Выполнено сопоставление клинико-демографических и ангиографических характеристик пациентов, а также особенностей реализованных стратегий реваскуляризации в двух группах больных: с летальным исходом (n=17) и без летального исхода (n=310). Изучена струк-тура и причины летальных исходов на протяжении 30 дней и 12 месяцев наблюдения.Результаты. Наиболее значимыми клинико-демографическими факторами летального исхода после реваскуляризации яви-лись: старший возраст -66,6±8,2 года (р=0,006); снижение фракции выброса левого желудочка (ФВ лЖ) -46,2±4,5 % (р=0,02); на-личие в анамнезе постинфарктного кардиосклероза (ПИКС) -у 35,3 % пациентов (р=0,04); исходно выраженная острая сердечная недостаточность (Killip 2) -у 29,4 % больных (р=0,05). Анатомо-ангиографическими и интраоперационными факторами смертель-ного исхода стали: неуспешное ЧКВ (финальный кровоток по целевой артерии ниже tIMI3 и/или наличие значимых осложнений) (р=0,0001) и исходная тяжесть поражения коронарного русла по шкале SYNtAX (р=0,03).Заключение. Комплексная оценка клиническо-демографических и анатомо-ангиографических факторов позволяет выявить пациентов с ИМпSt и МП, имеющих высокий риск летального исхода после первичного ЧКВ, и осуществлять поиск оптимальных стратегий реваскуляризации и медикаментозной терапии для этой тяжелой группы больных.Ключевые слова: инфаркт миокарда с элевацией сегмента St, многососудистое поражение коронарного русла, первичное чрескожное коронарное вмешательство, факторы летального исхода. FACTORS OF MORTALITY IN ST-ELEVATION MYOCARDIAL INFARCTION PATIENTS WITH MULTIVESSEL CORONARY DISEASE AFTER ENDOVASCULAR REVASCULARIZATION R. S. TARASOV, V. I. GANUKOV Federal State Budgetary Scientific Institution Research for Complex Issues of Cardiovascular Diseases, Laboratory of Interventional Cardiology, Kemerovo, RussiaPurpose. to identify demographic and clinical-anatomic and angiographic factors associated with fatal outcome after primary percutaneous coronary intervention (PCI) in patients with St-elevation myocardial infarction (StEMI) and multivessel disease (MVd) of coronary arteries within 12 months.Materials and methods. the study included 327 consecutive patients with StEMI and MVd of coronary arteries who received primary PCI. Clinical, demographic and angiographic ch...

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“…[11][12][13] Functional flow resistance (FFR) studies are now emerging which suggest that the functional stenosis of non-CLs are indeed often over estimated on angiogram after acute STEMI. 28 The concept of preventative PCI introduced by PRAMI implies that non-CLs will develop into more serious disease at a later date. Using Intravascular Ultrasound of 99 non-CLs in 63 patients Zhao et al found a trend towards atherosclerotic evolution of lower risk lesions to higher risk lesions over a 13 month period; including decreased minimum luminal area, and increased size of necrotic core.…”

Section: Future Development Of This Researchmentioning

confidence: 99%

Management and outcomes of significant non-culprit coronary artery lesions in STEMI: a retrospective cohort study

Weitemeyer¹,

Murphy²,

Gillen³

et al. 2015

ICFJ

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BackgroundIn the setting of ST-elevation myocardial infarction (STEMI) and multi-vessel disease (MVD), guidelines recommend revascularization of the culprit lesion (CL) only, due to poor evidence supporting intervention in non-culprit lesions (non-CLs) during the same index procedure. Debate over management for significant non-CLs is of interest i.e. medical management vs. percutaneous revascularization. We describe a cohort of patients with STEMI and MVD and compare the occurrence of major adverse cardiac events (MACE) by therapeutic strategies for non-CLs with regard to follow-up outcomes.

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Non-culprit lesions detected during primary PCI: treat invasively or follow the guidelines?

Cited by 80 publications

References 20 publications

Treatment of non-culprit lesions detected during primary PCI: long-term follow-up of a randomised clinical trial

Treatment of non-culprit lesions detected during primary PCI: long-term follow-up of a randomised clinical trial

Factors of Mortality in St-Elevation Myocardial Infarction Patients With Multivessel Coronary Disease After Endovascular Revascularization

Management and outcomes of significant non-culprit coronary artery lesions in STEMI: a retrospective cohort study

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