Visual Assessment for Non-Culprit Lesion Revascularization

There is evidence in favor of complete revascularization in the context of ST elevation MI with multivessel disease where primary PCI has been successful. 

However, the small print in these studies should be read carefully. Should revascularization be completed during index intervention, index hospitalization or after discharge? Should complete revascularization be based on visual assessment, quantitative angiography, intravascular imaging, invasive functional criteria, or stress test imaging? 

The latest studies tend to simplify: non-culprit lesions can be revascularized after primary PCI. 

The present study, recently published in JACC, follows the same idea: defining non-culprit lesions with quantitative angiography.

In 4041 patients from the COMPLETE study, non-culprit lesions were analyzed mostly with quantitative angiography (n=3851). 

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The pre-specified analysis determined the impact of stenosis severity >60% vs. <60% by quantitative angiography on the primary end point of cardiovascular death or new MI.

The secondary end point was a combination of cardiovascular death, new MI and ischemia driven revascularization.

Primary end point was reduced in 2479 patients presenting >60% stenosis severity by quantitative angiography (2.5% vs. 4.2%; HR: 0.61; CI 95%: 0.47 to 0.79) but not in the 1372 patients with non-culprit stenosis severity <60% (3% vs 2.9%; HR 1.04, CI 95%; 072 to 1.5).

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The secondary end point saw similar outcomes.

Conclusion

In patients undergoing ST elevation acute coronary syndrome with multivessel disease, complete revascularization reduces events when quantitative angiography of non-culprit lesions shows >60% stenosis severity. 

Título original: Nonculprit Lesion Severity and Outcome of Revascularization in Patients With STEMI and Multivessel Coronary Disease.

Referencia: Tej Sheth et al. J Am Coll Cardiol 2020;76:1277–86. https://doi.org/10.1016/j.jacc.2020.07.034.

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