Exaggeration of nonculprit stenosis severity during acute myocardial infarction: implications for immediate multivessel revascularization

Hanratty, Colm G.; Kōyama, Yutaka; Rasmussen, Helge H.; Nelson, G.; Hansen, Peter S.; Ward, Michael R.

doi:10.1016/s0735-1097(02)02049-1

Cited by 168 publications

(94 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…One may overestimate the severity of nonculprit lesions in the acute phase [18], overlook the unfavourable prothrombotic and inflammatory milieu of the hyperacute phase of infarction [19,20], the adjunctive jeopardization of noninfarcted areas of myocardium, and the increased contrast nephropathy risk [21] due to the necessity of a longer procedure. On the other hand, the advances in technology and the more aggressive pharmacologic approach during primary PCI may result in a safer and more effective procedure.…”

Section: Discussionmentioning

confidence: 99%

Single or multivessel percutaneous coronary intervention in ST‐elevation myocardial infarction patients

Varani

Balducelli

Aquilina

et al. 2008

Cathet Cardio Intervent

View full text Add to dashboard Cite

show abstract

Section: Discussionmentioning

confidence: 99%

Single or multivessel percutaneous coronary intervention in ST‐elevation myocardial infarction patients

Varani

Balducelli

Aquilina

et al. 2008

Cathet Cardio Intervent

View full text Add to dashboard Cite

show abstract

“…15 The best revascularisation strategy of the non-culprit lesions is not, therefore, well established. 16 Apart from the potential overestimation of the severity of non-IRA due to heightened vascular tone, 17 major concerns when attempting CR in a STEMI derive from: the prolongation of the primary PCI procedure, which will increase the volume of contrast medium used with its inherent risk of contrast-induced nephropathy; 18 the risk of jeopardising viable myocardium during revascularisation of a non-IRA; and the higher risk of stent thrombosis by operating in the highly thrombogenic peri-infarction milieu. More extensive acute revascularisation in patients with STEMI may be safer in the current era due to advances in stent technology and antiplatelet therapy, mainly in higher risk subgroups.…”

Section: 210mentioning

confidence: 99%

Is Complete Revascularisation Mandated for all Patients with Multivessel Coronary Artery Disease?

Caterina

Innocentiis

Zimarino

2017

Interventional Cardiology Review

View full text Add to dashboard Cite

CoronaryMultivessel coronary artery disease (MVCAD) is defined by the presence of ≥50 % diameter stenosis of two or more epicardial coronary arteries.The presence of MVCAD indicates poorer prognosis and a significantly higher mortality than single-vessel disease. In MVCAD, revascularisation can be achieved by either percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG).1,2 A comprehensive definition of the adequacy of myocardial revascularisation should take into account the size of the vessel, the angiographic and functional severity of the lesion, and the viability of the myocardial territory. 3 Accordingly, anatomic and functional complete revascularisation (CR) are not always synonymous. Generally, the anatomic CR is defined by treatment of all ≥50 % stenosis in vessels of ≥1.5 mm diameter, whereas functional CR is defined by treatment of all lesions assessed as functionally relevant (with both invasive or non-invasive methods) in the presence of myocardial viability in the dependent territory, see Table 1. 3At present, only a few trials have been specifically designed to directly evaluate the adequacy of revascularisation. Current literature, mostly relying on meta-analyses of non-randomised observational studies, 4,5 lists the adequacy of revascularisation among factors that should guide the choice of treatment strategy. In most patients with MVCAD, the main advantage of CABG over PCI seems to be conferred by the achievement of more extensive revascularisation. Most of the difference in terms of the benefit of CABG over PCI seems to derive from patients who undergo incomplete revascularisation (IR). As documented in a recent patient-level analysis, long-term mortality was similar between patients undergoing CR with either PCI or CABG, whereas it was significantly higher with IR after PCI than CABG. 6Although much less invasive than traditional CABG, PCI yields lower rates of CR in patients with multiple coronary lesions. 7 IR can occasionally be implemented in addition to CABG in order to reduce complications, mainly when minimally invasive or off-pump surgery is attempted. AbstractIn multivessel coronary artery disease (MVCAD), myocardial revascularisation can be achieved by percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG), with complete revascularisation on all diseased coronary segments or with incomplete revascularisation on selectively targeted lesions. Complete revascularisation confers a long-term prognostic benefit, but is associated with a higher rate of periprocedural events compared with incomplete revascularisation. In most patients with MVCAD, the main advantage of CABG over PCI is conferred by the achievement of more extensive revascularisation. According to current international guidelines, PCI is generally preferred in single-vessel disease, low-risk MVCAD or isolated left main disease; whereas CABG is usually recommended in patients with complex two-vessel disease, most patients with three-vessel disease and/or non-isolate...

show abstract

“…5 Thus, one may hypothesize that treating the bystander disease during the peri-infarct period may reduce the incidence of recurrent ischemia derived from nonculprit lesions, and this in turn could reduce overall ischemic burden and obviate the need for recurrent procedures. Conversely, assessment of bystander disease severity, both visually and functionally, may be difficult in the acute setting, 6 and thus treating these stenoses may not be wholly justified at the time of index intervention. Furthermore, multivessel revascularization is associated with coronary microembolization, iatrogenic myocardial infarction (MI), coronary reserve reduction, 7 and increased risk of contrast nephropathy.…”

Section: Iqbal Et Al Ppci For Stemi and Multivessel Disease 937mentioning

confidence: 99%

Culprit Vessel Versus Multivessel Intervention at the Time of Primary Percutaneous Coronary Intervention in Patients With ST-Segment–Elevation Myocardial Infarction and Multivessel Disease

Iqbal

Ilsley

Kabir

et al. 2014

Circ: Cardiovascular Quality and Outcomes

View full text Add to dashboard Cite

Background-It is estimated that up to two thirds of patients presenting with ST-segment-elevation myocardial infarction have multivessel disease. The optimal strategy for treating nonculprit disease is currently under debate. This study provides a real-world analysis comparing a strategy of culprit-vessel intervention (CVI) versus multivessel intervention at the time of primary percutaneous coronary intervention in patients with ST-segment-elevation myocardial infarction. Methods and Results-We compared CVI versus multivessel intervention in 3984 patients with multivessel disease undergoing primary percutaneous coronary intervention between 2004 and 2011 at all 8 tertiary cardiac centers in London. Multivariable-adjusted models were built to determine independent predictors for in-hospital major adverse cardiovascular events (MACEs) and all-cause mortality at 1 year. To reduce confounding and bias, propensity score methods were used. CVI was associated with reduced in-hospital MACE (4.6% versus 7.2%; P=0.010) and mortality at 1 year (7.4% versus 10.1%; P=0.031). CVI was an independent predictor for reduced in-hospital MACE (odds ratio, Key Words: culprit artery ◼ multivessel percutaneous coronary intervention ◼ primary percutaneous coronary intervention ◼ ST-segment elevation myocardial infarction

show abstract

Exaggeration of nonculprit stenosis severity during acute myocardial infarction: implications for immediate multivessel revascularization

Abstract: Significant exaggeration of nonculprit lesion stenosis severity occurs at infarct angiography, which may affect revascularization decision making in an appreciable number of patients.

Cited by 168 publications

References 20 publications

Single or multivessel percutaneous coronary intervention in ST‐elevation myocardial infarction patients

Single or multivessel percutaneous coronary intervention in ST‐elevation myocardial infarction patients

Is Complete Revascularisation Mandated for all Patients with Multivessel Coronary Artery Disease?

Culprit Vessel Versus Multivessel Intervention at the Time of Primary Percutaneous Coronary Intervention in Patients With ST-Segment–Elevation Myocardial Infarction and Multivessel Disease

Contact Info

Product

Resources

About