Percutaneous transluminal coronary angioplasty of the “culprit lesion” for management of unstable angina pectoris in patients with multivessel coronary artery disease

Wohlgelernter, Daniel; Cleman, Michael; Highman, H. A.; Zaret, Barry L.

doi:10.1016/0002-9149(86)90015-9

Cited by 93 publications

(13 citation statements)

References 18 publications

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“…24 In 2 cases in our series, ICA was unable to define the culprit lesion, given multiple severe lesions and no angiographic pattern of plaque instability. We did observe a region of MPD with matching RWMA in both of these cases on CT, which suggests the potential of CT to aid in the identification of culprit lesions in certain scenarios and may be particularly helpful in multivessel versus Culprit-vessel management decisions.…”

Section: Discussionmentioning

confidence: 70%

Incremental value of myocardial perfusion over regional left ventricular function and coronary stenosis by cardiac CT for the detection of acute coronary syndromes in high-risk patients: A subgroup analysis of the ROMICAT trial

Bezerra

Loureiro

Irlbeck

et al. 2011

Journal of Cardiovascular Computed Tomography

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Section: Discussionmentioning

confidence: 70%

Incremental value of myocardial perfusion over regional left ventricular function and coronary stenosis by cardiac CT for the detection of acute coronary syndromes in high-risk patients: A subgroup analysis of the ROMICAT trial

Bezerra

Loureiro

Irlbeck

et al. 2011

Journal of Cardiovascular Computed Tomography

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“…At followup, 66% of patients with complete revascularization were asymptomatic and 84% had clinical improvement; this was similar to 58% and 85%, respectively, for patients with incomplete revascularization [10]. Thus, incomplete revascularization seems to be a valuable solution when a culprit lesion can be identified, particularly when this vessel is a favourable lesion which serves a large noninfarct territory, or in case of an acute coronary syndrome where there is the need to stabilize patient's condition [11, 12]. Moreover, in the Arterial Revascularization Therapies Studies (ARTS), randomization of stenting in patients with incomplete revascularization including diabetics did not influence late mortality [13].…”

Section: Historical and Updated Background Of Anatomical Incompletmentioning

confidence: 82%

Role of Stress Myocardial Scintigraphy in the Evaluation of Incompletely Revascularized Post-PCI Patients

Galassi

Marzà

Azzarelli

et al. 2011

International Journal of Molecular Imaging

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Percutaneous coronary intervention (PCI) is actually the most used method of revascularization. Although complete revascularization remains a desirable goal, it may not be possible or not easy to plan in many patients. Thus, incomplete revascularization might be a preferred treatment strategy in selected patient categories. Stress myocardial scintigraphy, because of its high diagnostic accuracy and prognostic value and its ability to assess location and extent of myocardial ischemia regardless of symptoms as well as to evaluate patients who are unable to exercise or who have uninterpretable electrocardiogram, is of paramount importance for clinical decision making in patients with multivessel disease and incomplete revascularization.

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“…Late survival, survival free of MI, subsequent CABG, persistent angina, and exerciseinduced ischemia were similar or increased in the Non-CLI strategy as compared with a CLI strategy. [25][26][27] In an early study, Kahn et al showed that in patients with MI and MVD, primary angioplasty had favorable survival rates with CLI strategy and future-staged PCI of non-CLs. 2 Studies in the bare metal stent era have reported lower success rates, higher MACE rates, higher rates of reinfarction, higher target vessel revascularization, higher initial costs, and a higher risk of death with the Non-CLI strategy.…”

Section: Proculprit Lesion Interventionmentioning

confidence: 99%

Coronary Revascularization Strategy for ST Elevation Myocardial Infarction with Multivessel Disease: Experience and Results at 1-Year Follow-Up

Mohamad

Kondur

et al. 2011

American Journal of Therapeutics

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Primary percutaneous coronary intervention (PCI) of culprit lesions (CLs) is the standard of care in patients presenting with ST elevation myocardial infarction (STEMI). However, optimal revascularization strategy for significant nonculprit lesions (non-CLs) in the setting of STEMI remains controversial. The importance of defining of such a strategy lies in the fact that approximately 50% of patients with STEMI have multivessel disease (MVD). The aim of this study was to describe characteristics, therapeutic strategies, and 1-year outcomes in a cohort of patients with STEMI and MVD. We retrospectively analyzed a cohort of 63 patients with STEMI and MVD obtained from a 5-year catheterization database. MVD was defined as ≥70% stenosis of ≥2 epicardial coronary arteries. This cohort was followed for a period of 1 year for major adverse cardiac events (MACE was defined as acute coronary syndrome, new onset heart failure, or death) and all-cause mortality. PCI with stent placement was the major therapeutic procedure (87.5%) performed for CLs. Non-CLs did not undergo interventions in a majority of individuals (47.6%), while the remaining patients underwent PCI (29%) and coronary artery bypass graft surgery (22%) for non-CLs. At 1-year follow-up, prevalence of MACE events and death in the entire cohort were 30% and 15%, respectively. A trend for better outcomes (1-year cumulative MACE events but not mortality) was observed in CL-only intervention cohort compared with non-CL intervention. The PCI and Coronary artery bypass graft surgery cohorts did not show any significant difference in clinical outcomes. In this retrospective cohort of patients with MVD who presented with STEMI, no intervention of noncritical lesions was the prevalent approach, reflecting guideline recommendations. CL-only intervention strategy showed a better clinical outcome than non-CL intervention. Intervention of noncritical lesions therefore did not seem to improve MACEs or all-cause mortality at 1-year of follow-up and might in fact have had a detrimental effect on outcomes.

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Percutaneous transluminal coronary angioplasty of the “culprit lesion” for management of unstable angina pectoris in patients with multivessel coronary artery disease

Cited by 93 publications

References 18 publications

Incremental value of myocardial perfusion over regional left ventricular function and coronary stenosis by cardiac CT for the detection of acute coronary syndromes in high-risk patients: A subgroup analysis of the ROMICAT trial

Incremental value of myocardial perfusion over regional left ventricular function and coronary stenosis by cardiac CT for the detection of acute coronary syndromes in high-risk patients: A subgroup analysis of the ROMICAT trial

Role of Stress Myocardial Scintigraphy in the Evaluation of Incompletely Revascularized Post-PCI Patients

Coronary Revascularization Strategy for ST Elevation Myocardial Infarction with Multivessel Disease: Experience and Results at 1-Year Follow-Up

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