Staged re-evaluation of non-culprit lesions in ST segment elevation myocardial infarction: a retrospective study
Troels Thim1, Gro Egholm1, Kevin Kris Warnakula Olesen1
1Department of Cardiology , Aarhus University Hospital , Aarhus , Denmark.
Insights
In ST-elevation myocardial infarction (STEMI) patients treated with primary percutaneous coronary intervention (PCI), staged re-evaluation of non-culprit lesions was needed in 24%. No adverse events occurred during the waiting period for staged intervention.
Area of Science:
- Cardiology
- Interventional Cardiology
- Acute Coronary Syndromes
Background:
- Complete revascularization strategies in ST-elevation myocardial infarction (STEMI) are debated.
- Optimal timing for revascularizing non-culprit lesions remains unclear.
Purpose of the Study:
- To quantify the need for re-evaluation of non-culprit lesions after primary PCI in STEMI patients.
- To determine the outcomes of staged re-evaluation and intervention.
- To assess adverse cardiac events during the waiting period for staged procedures.
Main Methods:
- Retrospective observational study of STEMI patients undergoing primary PCI.
- Analysis of non-culprit lesion evaluation and subsequent interventions.
- Tracking of adverse cardiac events during the interim period.
Main Results:
- 24% of STEMI patients required non-culprit lesion re-evaluation after primary PCI.
- 66.4% of these patients underwent staged revascularization.
- No adverse events were observed during the waiting time for staged re-evaluation or intervention.
Conclusions:
- Staged re-evaluation of non-culprit lesions is necessary in a significant proportion of STEMI patients post-primary PCI.
- Staged intervention appears safe, with no observed adverse events during the waiting period.
Objective:
It remains unknown whether complete revascularisation is optimally performed in patients with ST segment elevation myocardial infarction (STEMI) during the index or at staged procedures. The aims of this study were to quantify the number of primary percutaneous coronary intervention (PCI) procedures in which non-culprit lesions needed further evaluation, to determine the consequence of the re-evaluation and to quantify adverse cardiac events during the waiting time for re-evaluation and intervention.
Methods:
The study was observational and retrospective and included all patients with STEMI treated with primary PCI during 1 year at our centre.
Results:
Among the 507 patients with STEMI, 374 were considered sufficiently treated with culprit lesion PCI only. Complete primary multivessel revascularisation was performed in 11 patients. Non-culprit lesion re-evaluation was planned for 122 patients (24%). Of these 122 patients, 3 patients died during their index admission. Follow-up data were not available for 3 patients. Among the 116 patients, 187 non-culprit lesions were re-evaluated and 77 patients (66.4%) underwent revascularisation with treatment of 119 lesions (63.3%). Re-evaluation was performed after a median of 30 days (25th centile: 9 days, 75th centile: 35 days). During the waiting time for re-evaluation, two patients underwent a new primary PCI due to stent thrombosis of the index culprit lesion.
Conclusions:
Staged re-evaluation of non-culprit lesions observed in patients with STEMI was required in 24% of a primary PCI cohort. Intervention was performed in 66.4% of patients scheduled for re-evaluation. We observed no adverse events related to the non-culprit lesions during the waiting time for a staged re-evaluation or intervention.
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