Author + information
Conventional knowledge indicates that majority of ruptured atherosclerotic plaques causing ST-segment elevation myocardial infarction (STEMI) are moderate stenosis of less than 50% diameter stenosis. We decided to explore this by analysing the lesions in our patients who presented with STEMI undergoing primary percutaneous coronary intervention (PPCI) in our centre.
All patients undergoing PPCI between Jan 2009 to Aug 2010 were included in the analysis. Quantitative coronary angiography (QCA) was performed in the culprit lesions immediately after antegrade flow is restored by thrombectomy, low profile balloon predilation or guidewires.
A total of 736 (-9) patients were included in this study. The mean age of the cohort was 57+12 years, with 629 (85%) males being majority. Diabetes mellitus was present in 29% of patients. Lesion measurement was carried out after coronary flow was restored in 542 (73%) patients by thrombectomy, 168 (23%) by balloon dilatation and 26 (4%) following guidewire passage across the lesion. TIMI 2/3 flow was established in 719 (98%) patients. The mean minimal luminal diameter (MLD) was 1.05+0.49mm, mean reference vessel diameter was 2.80+0.64mm, mean diameter stenosis was 62+16%, and mean lesion length was 16+7mm. The distribution of lesion severity of the culprit lesions were: diameter stenosis: <50% (21%), 50% to 70% (41%) and ≥70% (38%), p <0.01. Univariate analysis did not reveal any significant association of high grade (>50%) stenoses with age, gender, and risk factors.
The majority (79%) of patients presenting with STEMI had lesions greater than 50% diameter stenosis. This contradicts existing paradigm and constitutes new understanding of the STEMI disease process.
Poster Sessions, Expo North
Saturday, March 09, 2013, 3:45 p.m.-4:30 p.m.
Session Title: STEMI Topics
Abstract Category: 1. Acute Coronary Syndromes: Clinical
Presentation Number: 1171-216
- 2013 American College of Cardiology Foundation