Culprit lesion only versus culprit vessel revascularization in primary percutaneous coronary intervention for patients presenting with acute ST segment elevation myocardial infarction

Background: Emergent percutaneous coronary intervention (PCI) of the culprit lesion (CL) with stenting is the preferred treatment strategy in the setting of acute stent thrombosis elevation myocardial infarction (STEMI) to restore the blood flow through the occluded coronary vessel. The aim of this work was to assess and compare the contemporary primary PCI strategies in patients of acute STEMI with multiple stenotic lesions in the infarct-related artery (IRA) with either complete or CL only (CLO) revascularization and its influence on short-term outcome. Methods: This prospective study was carried out on 314 patients with acute STEMI and treated with primary PCI within 24 hours of presentation. Patients were divided into two groups according to the PCI strategy: Group I (n=208): culprit lesion only revascularization (CLO) and group II (n=106): culprit vessel revascularization (CV). Results: TIMI flow score was better in the CLO group after complete index procedure and after delayed complete culprit vessel revascularization than ad-hoc strategy in the CV group (P = 0.001). The incidence of early stent thrombosis and slow or no reflow phenomenon was higher in the CV group (P< 0.001). There was no significant difference between both groups as regard pre-procedural TIMI flow score, non-angiographic in-hospital complications and the major adverse cardiovascular events as all (MACE) within 3 months follow up after the index primary PCI. Conclusions: In the presence of an additional lesion in the CV during primary PCI, deferred stenting for the non- CL of the IRA after stenting the CL may be considered to prevent the development of slow or no-reflow, stent thrombosis (ST) and thus major clinical adverse events.