Original title: Impact of Nonculprit Vessel Myocardial Perfusion on Outcomes of Patients Undergoing Percutaneos Coronary OIntervention for Acute Coronary Síndromes. Analysis From ACUITY Trial. Reference: Alexandra Lansky, et al. JAAC Cardiovascular Intervention 2014,7:266-275

In Non ST elevation Acute Coronary Syndrome (NSTE-ACS) is demonstrated that revascularization of the culprit vessel is beneficial, but strategy it is not yet clear as well as evolution of other injuries. In this angiographic sub study of the ACUITY study, 3626 patients with moderate or high risk NSTE-ACS with 3-vessel disease who received angioplasty were analyzed.

The primary end point at 30 days and one year was the composite of death from any cause, myocardial infarction, unplanned revascularization justified by ischemia and major bleeding not related to surgery. 3426 patients (89.5 %) with non-culprit lesions were analyzed, 10.9 % had Blush, 0 /1, 13.9 % Blush 2 and 75.2 % Blush 3. Those with decreased Blush in no culprit lesion were older, diabetic, hypertensive, with a history of previous angioplasty and more complex lesions.

The primary end point at 30 days and 12 months was higher in the group with decreased Blush of not guilty vessel. Predictors at12-month of death / myocardial infarction were: not guilty injury with Blush 0/1, previous myocardial infarction, renal failure, positive bio markers, commitment of ST-segment and 3-vessel disease. In those in which the culprit vessel was revascularized, the fact of presenting a Blush 0 /1 in the not guilty vessel was a mortality predictor.

Conclusion

The reduction of myocardial perfusion in the non- culprit vessel is associated with increased short and long-term mortality in patients admitted with NSTEMI. In patients receiving angioplasty, decreased Blush in the culprit vessel was able to stratify risk in those that a preserved flow of the culprit vessel was achieved. 

Editorial comment

This sub study shows that in this patients group is very important to evaluate the remaining lesions at the time of decision making, being a little more aggressive with revascularization, as this is a group with more comorbidities and greater threat of myocardial ischemia, resulting in a worse future developments. 

Courtesy of Dr. Carlos Fava
Interventional Cardiologyst
Fundacion Favaloro
Argentina

Dr. Carlos Fava para SOLACI.ORG