Evaluation of non-culprit lesions in patients with ST-segment Elevation Myocardial Infarction with Optical Coherence Tomography

Abstract

Primary percutaneous coronary intervention (PCI) is the preferred method of reperfusion for patients with ST-segment elevation myocardial infarction (STEMI) (1-4). These patients often have multivessel coronary artery disease, with additional angiographically significant lesions in locations separate from that of the culprit lesion that caused the acute event (5). Whether to routinely revascularize these non-culprit lesions or to manage them conservatively with guideline based medical therapy alone is a common dilemma (6-8). Non-culprit lesions, which are usually discovered incidentally at the time of primary PCI, may represent stable coronary artery plaques, for which additional revascularization may not offer additional benefit (9). However, if non-culprit lesions have morphologic features consistent with unstable plaques, which confer an increased risk of future cardiovascular events, there may be a benefit of routine non-culprit-lesion PCI (10, 11)...La angioplastia primaria es el método preferido de reperfusión para pacientes con sindrome coronario agudo con elevación del segmento ST (1-4). Estos pacientes usualmente tienen enfermedad coronaria multivaso, con lesiones angiográficamente significativas en segmentos lejanos a la lesión culpable que causo el evento primario (5). Existe un dilema acerca de si tratar estas lesiones no culpables con revascularización rutinaria o manejarlas conservadoramente solo con terapia medica óptima (6-8). Las lesiones no culpables que se descubren incidentalmente al momento de la angioplastia primaria, pueden representar placas coronarias estables para las cuales revascularización adicional no ofrece beneficio (9). Sin embargo, si las lesiones no culpables tienen características morfológicas consistentes con placas inestables que confieren un riesgo incrementado de eventos cardiovasculares futuros; puede haber un beneficio considerando intervencionismo rutinario (10, 11)...