Key result
PPCI exaggerates non-culprit stenosis severity by ~7% versus non-PPCI settings.
Why the study?
It was unclear if the severity of non-culprit coronary artery stenosis is affected by primary percutaneous coronary intervention compared with non-PPCI settings.
Does the primary percutaneous coronary intervention (PPCI) setting exaggerate the angiographic severity of non-culprit coronary artery stenosis compared to non-PPCI settings in patients with multi-vessel coronary artery disease?
Observational (n=69)
Blinded assessors
No
Does the primary percutaneous coronary intervention (PPCI) setting exaggerate the angiographic severity of non-culprit coronary artery stenosis compared to non-PPCI settings in patients with multi-vessel coronary artery disease?
Absolute Event Rate: 71.6% vs 64.5%
p-value: p=≤ 0.001
Angiographic assessment during the acute phase of primary PCI may exaggerate the severity of non-culprit lesions compared to staged assessments, which could impact revascularization decisions.
Non-culprit stenoses appear exaggerated on PPCI angiograms; leaves open whether staged reassessment should alter revascularization thresholds in multivessel disease.
Objective: We sought to evaluate if the non-culprit coronary artery stenosis severity is affected by primary percutaneous coronary intervention (PPCI) compared with non-PPCI settings. Methods: Review of all the PPCI angiograms was performed at our catheterization laboratory between 15th October 2013 and 15th October 2014. All patients with severe multi-vessel coronary artery disease (MV CAD) who underwent second angiograms (either during the same admission or after discharge) were analyzed. Non-culprit lesions in the PPCI and non-PPCI angiograms were compared. Two investigators blinded to the procedure dates analyzed the severity of the lesions using validated quantitative coronary angiography software (QCA). Results: Among 777 patients who underwent PPCI, 458 had multi-vessel disease. Additional angiography to treat non-culprit lesions was performed in 104, of these, 69 patients had a combined total of 74 lesions suitable for QCA analysis. The second angiogram was performed during the same admission (mean 4± 2.7 days) and after discharge (mean 115± 84 days) for 48 and 21 patients, respectively. Compared to PPCI angiograms, the non-PPCI angiograms showed a statistically significant reduction in the percentage of stenosis (71.6± 14.4% vs 64.5± 14.4%, p ≤ 0.001), and an increase in minimal luminal diameter (0.82± 0.45 mm vs 1.00± 0.44 mm, p ≤ 0.001) of non-culprit lesion. However, no significant difference was observed in the reference diameter (2.89± 0.69 mm vs 2.83± 0.64 mm, p =0.1) of the non-culprit lesion in both angiograms. Furthermore, these differences in the lesion parameters remain constant whether the second angiogram was performed during the same admission or performed after discharge (73.3± 14% and 66.2± 12.9% vs 68.4± 15% and 61.2± 16%, p =0.1). Conclusion: The severity of non-culprit lesion is exaggerated in the PPCI setting. The non-culprit lesion exaggeration remains constant whether the second angiogram was performed early within a few days or later after several weeks.
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Othman et al. (2021) conducted an observational in Multi-vessel coronary artery disease in the setting of acute myocardial infarction (n=69). Primary percutaneous coronary intervention (PPCI) setting vs. Non-PPCI setting (second angiogram) was evaluated on Percentage of stenosis of non-culprit lesion (p=≤ 0.001). The severity of non-culprit coronary artery stenosis was significantly exaggerated during primary percutaneous coronary intervention compared to non-PPCI settings (71.6% vs 64.5%, p≤0.001).
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