Non-culprit coronary artery percutaneous coronary intervention during acute ST-segment elevation myocardial...

Area of Science:

• Cardiology
• Interventional Cardiology
• Clinical Outcomes Research

Background:

• Multi-vessel coronary artery disease (MVD) is common in ST-elevation myocardial infarction (STEMI) patients.
• Primary percutaneous coronary intervention (PCI) addresses the infarct-related artery (IRA).
• The role of non-culprit intervention during primary PCI remains debated.

Purpose of the Study:

• To determine the incidence of non-culprit PCI during primary PCI.
• To assess the association between non-culprit PCI and 90-day outcomes in STEMI patients with MVD.
• To evaluate the propensity for performing non-culprit PCI.

Main Methods:

• Analysis of data from the APEX-AMI trial.
• Inclusion of STEMI patients with MVD who underwent primary PCI.
• Comparison of outcomes between patients receiving IRA-only PCI versus those with non-culprit PCI.

Main Results:

• Non-culprit PCI was performed in 9.9% of MVD patients.
• The 90-day mortality rate was significantly higher in the non-culprit PCI group (12.5% vs. 5.6%).
• Non-culprit PCI remained independently associated with increased 90-day mortality (aHR 2.44).

Conclusions:

• Non-culprit interventions at the time of primary PCI in MVD patients are associated with increased mortality.
• Findings support current guidelines against routine non-culprit PCI in stable primary PCI settings.
• Further investigation via a prospective randomized trial is suggested.