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

Mustafa Toma1, Christopher E Buller, Cynthia M Westerhout

  • 1Canadian VIGOUR Centre, University of Alberta, 2-51 Medical Sciences Building, Edmonton, AB, Canada T6G 2H7.

European Heart Journal
|June 10, 2010
PubMed

Insights

Performing non-culprit interventions during primary percutaneous coronary intervention (PCI) in ST-elevation myocardial infarction patients with multi-vessel coronary artery disease increases 90-day mortality risk. Current guidelines discouraging these procedures in stable patients are supported.

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.
Abstract

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