Management and outcomes of significant non-culprit coronary artery lesions in STEMI: a retrospective cohort study

Authors

  • Robert Erich Michael Weitemeyer University of Limerick, Graduate Entry Medical School University of Saskatchewan, Department of Family Medicine, Regina
  • Shane Peter Murphy University of Limerick, Graduate Entry Medical School, Castletroy, Co. Limerick, Ireland
  • Ruth Gillen University of Limerick, Graduate Entry Medical School, Castletroy, Co. Limerick, Ireland
  • Catriona Ahern University Hospital Limerick, Dept of Cardiology, Limerick, Ireland
  • Yousif Abusalma University Hospital Galway, Co Galway, Ireland
  • Hatim A Yagoub University Hospital Limerick, Co Limerick, Ireland
  • Bryan P Yan Chinese University of Hong Kong, Dept of Medicine and Therapeudics
  • Andrew E Ajani Royal Melborne Hospital, Dept of Cardiology, Melbourne, Victoria, Australia
  • Ailish Hannigan University of Limerick Graduate Entry Medical School, Limerick, Ireland
  • Tom J Kiernan University Hospital Limerick, Dept of Cardiology, Ireland

DOI:

https://doi.org/10.17987/icfj.v3i0.113

Abstract

BACKGROUND
In the setting of ST-elevation myocardial infarction (STEMI) and multi-vessel disease (MVD), guidelines recommend revascularization of the culprit lesion (CL) only, due to poor evidence supporting intervention in non-culprit lesions (non-CLs) during the same index procedure. Debate over management for significant non-CLs is of interest i.e. medical management vs. percutaneous revascularization. We describe a cohort of patients with STEMI and MVD and compare the occurrence of major adverse cardiac events (MACE) by therapeutic strategies for non-CLs with regard to follow-up outcomes.

METHODS
86 patients with STEMI and MVD were identified from a database of STEMI presentations to the University Hospital Limerick from Jan 2011 to April 2013. The occurrence of MACE was established by follow up with patients’ general practitioners.

RESULTS
48% of presentations had MVD. Predominant management for non-CLs was medical therapy alone comprising 58% (n=50) of patients, while 23% (n=20) of patients underwent PCI for non-CL, and 19% (n=16) had CABG.

Median follow up was 1.8 years (range 9–36 months).  We found no significant difference in the occurrence of MACE  between medical management of non-CLs and PCI of non-CLs (OR 1.10 95%CI 0.34, 3.56; p= 0.88). CABG however does show a trend to be superior to both PCI (OR 3.10 95%CI 0.54, 17.88; p= 0.21) and medical management (OR 2.83 95%CI 0.65, 12.27; P= 0.17) in non-CLs.

CONCLUSIONS
CABG appears superior to both PCI or medical management in preventing MACE over time, and PCI is not superior to medical management alone.

Author Biographies

Robert Erich Michael Weitemeyer, University of Limerick, Graduate Entry Medical School University of Saskatchewan, Department of Family Medicine, Regina

PGY1 Resident, Family Practice

University of Saskatchewan Department of Family Medicine, Regina Division

Shane Peter Murphy, University of Limerick, Graduate Entry Medical School, Castletroy, Co. Limerick, Ireland

First Year Intern, Mayo Clinic Department of Family Medicine

Ruth Gillen, University of Limerick, Graduate Entry Medical School, Castletroy, Co. Limerick, Ireland

Intern, National Health Service, Ireland

Catriona Ahern, University Hospital Limerick, Dept of Cardiology, Limerick, Ireland

Nurse, director of Cardiac Rehabilitation Clinic, University Hospital Limerick, Co. Limerick, Ireland

Yousif Abusalma, University Hospital Galway, Co Galway, Ireland

Specialist Registrar, Dept of Cardiology, University Hospital Galway, Co Galway, Ireland

Hatim A Yagoub, University Hospital Limerick, Co Limerick, Ireland

Specialist Registrar, Dept of Cardiology, University Hospital Limerick, Co Limerick, Ireland

Ailish Hannigan, University of Limerick Graduate Entry Medical School, Limerick, Ireland

Professor of Statistics, University of Limerick Graduate Entry Medical School

Tom J Kiernan, University Hospital Limerick, Dept of Cardiology, Ireland

Consultant Cardiologist University Hospital Limerick, Professor of Medicine University of Limerick Graduate Entry Medical School

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Published

2015-09-04

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Original Article