Comparison Between Primary Percutaneous Coronary Inter-vention To The Culprit Only Versus Culprit And Non-Culprit Vessels In ST Elevation Myocardial Infarction

Abstract

Background and aim: Primary percutaneous coronary intervention (p-PCI) has become the treatment of choice for patients presenting with ST-segment elevation myocardial infarction (STEMI) when it can be performed expedi-tiously by an experienced team. This strategy has been found to be superior to thrombolytic therapy in improving morbidity and mortality. The presence of multi-vessel disease (MVD) has been found to be associated with worse prognosis in patients with STEMI.Treatment strategies vary widely from an aggressive approach which treats all significant lesions in the acute phase of p-PCI to a conservative approach with p-PCI of only the infarct-related ar-tery (IRA) and subsequent medical therapy unless recurrent ischemia occurs. AimThis study aimed to compare the safety and efficacy of PCI for culprit vessel only (culprit PCI) and multi-vessel PCI (MVD-PCI) during p-PCI procedure in patients with STEMI and MVD.
Patients and methods: this study included 100 patients with acute STEMI who were amenable to p-PCI were ad-mitted to CCU department at Al Hussin university Hospital and El Marwa Cardiac Center. 100 Patients were divided in 2 groups; group A 50 Patients: complete coronary revascularisation during primary PCI. Group B 50 Patients: culprit-only revascularisation during primary PCI. The following done for all patients: An I-written informed consent was obtained from every patient before the procedure II-Detailed history taking: III. Complete clinical and general examination. IV. Standard ECG: using Fukuda 3channels (Japan). V. Routine Laboratory investigations: VI. Echocar-diography: Using Philips IE33 USA. II. PCI procedure.
Results: LV EF improved significantly after 6 month in group A EF increased from 50.3±4.1 to 55.4± 6.2 ( P value 0.003). While in group B, it increase non-significant from 49.9± 3.2 to 50.7 ± 4.2(P value 0.50). The improvement of EF was more observed in patients with anterior MI Incidence of MACCE in both groups was comparable during hospital stay, one month and 6month follow up .Three cases of MACE in group B while no MACE in group A. (P value 0.11) Safety of aggressive strategy for complete revascularization is comparable for culprit –only strategy as regard risk. CIN was observed in five patients of group A and three patients of group B (P value 0.52). Vascular complication .no cases in group B while only one case in group B P value 0.34. Door to balloon time less than 90m is associated with better EF in comparison to more than 90m.
Conclusionsa.Complete coronary revascularization during primary PCI in patients with multi-vessel disease is safe. b.Complete coronary revascularization during primary PCI is associated with better improvement of EF at 6 months espacially in patients with anterior wall myocardial infarction in comparison to culprit-only revascularization. c.Door to baloon time less than 90 minutes is associated with better EF in comparison to more than 90 minutes. d. No difference in incidence of MACE between complete and culprit-only revascularizations.