Changes in non-culprit lesion severity on follow-up coronary angiography after primary percutaneous coronary ıntervention

Öz

Aim: Non-culprit lesion severity has often been exaggerated at the time of acute ST segment elevation myocardial infarction (STEMI). We aimed to determine changes in non-culprit lesions severity on follow-up coronary angiography (CAG) and independent predictors of these changes. Material and Methods: We retrospectively evaluated the changes in non-culprit lesion stenosis on follow-up CAG which was done within 2 months after primary percutaneous coronary intervention (P-PCI) in patients presenting with STEMI. Results: 154 patients were included in this study and 207 non-culprit lesions (percentage diameter stenosis (PDS) ≥50%) were compared using quantitative coronary analyses (QCA). Minimal lumen diameter (1.30 ± 0.38 mm vs. 1.54 ± 0.46 mm, p<0.001) and reference vessel diameter (2.88 ± 0.66 mm vs. 2.92 ± 0.64 mm, p=0.001) were increased significantly and PDS (54.49 ± 9.38 vs. 47.5 ± 11.17, p<0.001) and percentage area stenosis (78.38 ± 8.65 vs. 71.29 ± 11.84, p= <0.001) were decreased significantly. There was no significant change in lesion length (13.52 ± 5.59 mm vs. 13.25 ± 5.31 mm, p= 0.078). 65 (31.4%) of these significant lesions (PDS ≥50% by QCA) were regressed (less than 50%) on follow-up CAG. In multivariable analyses; current smoking, clopidogrel use after the P-PCI and history of coronary artery disease were the independent predictors of decrease in PDS. Conclusion: Significant exaggeration of non-culprit lesion stenosis severity occurs at the time of acute STEMI.

Anahtar Kelimeler

• Primary percutaneous coronary intervention
• multi-vessel disease
• non-culprit lesion
• quantitative coronary analysis

Primer perkütan koroner girişimlerde sorumlu olmayan lezyonların kontrol koroner anjiyografide değişimleri

Öz

Amaç: Akut ST segment yükselmeli miyokard enfarktüsü (STEMI) sırasında sorumlu olmayan lezyonlar sıklıkla olduklarından daha ciddi görünürler. Kontrol koroner anjiyografi (KAG)'de sorumlu olmayan lezyonların şiddetindeki değişiklikleri ve bu değişikliklerin bağımsız prediktörlerini belirlemeyi amaçladık. Gereç ve Yöntem: STEMI ile başvuran ve primer perkütan koroner girişimden (P-PKG) sonraki 2 ay içinde kontrol KAG yapılan hastalarda sorumlu olmayan lezyonlardaki değişiklikleri retrospektif olarak değerlendirdik. Bulgular: Bu çalışmaya 154 hasta dahil edildi ve 207 (yüzde çap darlığı (YÇD) ≥50%) sorumlu olmayan lezyon kantitatif koroner analizler (QCA) kullanılarak karşılaştırıldı. Minimal lümen çapı (1,30 ± 0,38 mm'ye karşı 1,54 ± 0,46 mm, p <0,001) ve referans damar çapı (2,88 ± 0,66 mm'ye karşı 2,92 ± 0,64 mm, p = 0,001) önemli ölçüde arttı ve YÇD (54,49 ± 9,38'e karşı 47.5 ± 11.17, p <0.001) ve yüzde alan darlığı (78.38 ± 8.65 vs. 71.29 ± 11.84, p= <0.001) anlamlı olarak azaldı. Lezyon uzunluğunda anlamlı değişiklik izlenmedi (13,52 ± 5,59 mm'ye karşı 13,25 ± 5,31 mm, p= 0,078). Bu önemli lezyonların 65'i (% 31.4) (QCA'ya göre YÇD ≥% 50) kontrol KAG'de geriledi (% 50'den az). Çok değişkenli analizlerde; mevcut sigara kullanımı, P-PKG'den sonra klopidogrel kullanımı ve koroner arter hastalığı öyküsü, YÇD'deki azalmanın bağımsız prediktörleri idi. Sonuç: Akut STEMI sırasında sorumlu olmayan lezyonlardaki darlıkların derecesi önemli ölçüde daha artmış olarak izlenmektedir.

Anahtar Kelimeler

• Primer perkütan koroner girişim
• çoklu damar hastalığı
• sorumlu olmayan lezyon
• kantitatif koroner analiz

Kaynakça

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