Complete Treatment Versus Residual Lesion - Long-Term Evolution After Acute Coronary Syndrome
Alexandre de Matos Soeiro1, Marco Antônio Scanavini Filho1, Aline Siqueira Bossa1
1Instituto do Coração (InCor), Hospital das Clínicas, Universidade de São Paulo, SP, Brazil.
Insights
Treating only the main artery blockage in acute coronary syndromes (ACS) appears safe. This study found no long-term differences in major cardiac events for patients with or without residual lesions in other arteries.
Area of Science:
- Cardiology
- Interventional Cardiology
- Clinical Research
Background:
- Recent studies question the necessity of treating non-culprit lesions in acute coronary syndromes (ACS).
- This study addresses the clinical implications of residual non-culprit lesions after primary percutaneous coronary intervention.
Purpose of the Study:
- To compare long-term outcomes of patients with acute coronary syndromes (ACS) treated for the culprit artery only.
- To evaluate differences in combined cardiac events between patients with significant residual non-culprit lesions versus those without.
Main Methods:
- Retrospective, observational study of 580 patients (May 2010-May 2013).
- Patients were divided into two groups: Group I (significant residual non-culprit lesions) and Group II (no residual lesions).
- Primary outcome: combined major adverse cardiac events (MACE) including reinfarction, angina, death, heart failure, and reintervention. Long-term analysis used Kaplan-Meier method with a mean follow-up of 9.86 months.
Main Results:
- No significant difference in the rate of combined cardiac events between Group I (31.9%) and Group II (35.6%) (p = 0.76).
- Mean patient age was similar in both groups (63 years in Group I, 62 years in Group II).
Conclusions:
- Treating the culprit artery alone in ACS patients is a safe strategy.
- No significant long-term differences in combined endpoints were observed between patients with and without significant residual lesions in non-culprit arteries.
Introduction:
A recently published study raised doubts about the need for percutaneous treatment of nonculprit lesions in patients with acute coronary syndromes (ACS).
Methods:
Retrospective, unicentric, observational study.
Objective:
To analyze the long-term outcomes in patients undergoing treatment of the culprit artery, comparing those who remained with significant residual lesions in nonculprit arteries (group I) versus those without residual lesions in other coronary artery beds (group II). The study included 580 patients (284 in group I and 296 in group II) between May 2010 and May 2013. We obtained demographic and clinical data, as well as information regarding the coronary treatment administered to the patients. In the statistical analysis, the primary outcome included combined events (reinfarction/angina, death, heart failure, and need for reintervention). The comparison between groups was performed using the chi-square test and ANOVA. The long-term analysis was conducted with the Kaplan-Meier method, with a mean follow-up of 9.86 months.
Results:
The mean ages were 63 years in group I and 62 years in group II. On long-term follow-up, there was no significant difference in combined events in groups I and II (31.9% versus 35.6%, respectively, p = 0.76).
Conclusion:
The strategy of treating the culprit artery alone seems safe. In this study, no long-term differences in combined endpoints were observed between patients who remained with significant lesions compared with those without other obstructions.
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