Exaggeration of Non-Culprit Coronary Artery Stenosis in the Setting of Primary Percutaneous Coronary Intervention: A Single Center Observational Study

Fahmi Othman,1 Abdul Rehman Abid,1 Awad AlQahtani,1 Abdurrazzak Gehani,2 Jassim Al Suwaidi,1 Abdulrahman Arabi1 1Heart Hospital, Hamad Medical Corporation, Doha, Qatar; 2Al-Ahli Hospital, Doha, QatarCorrespondence: Fahmi OthmanHeart Hospital, Hamad Medical Corporation, PO Box 3050, Doha, QatarTel +97466580459Email fothman@hamad.qaObjective: We sought to evaluate if the non-culprit coronary artery stenosis severity is affected by primary percutaneous coronary intervention (PPCI) compared with non-PPCI settings.Methods: Review of all the PPCI angiograms was performed at our catheterization laboratory between 15th October 2013 and 15th October 2014. All patients with severe multi-vessel coronary artery disease (MV CAD) who underwent second angiograms (either during the same admission or after discharge) were analyzed. Non-culprit lesions in the PPCI and non-PPCI angiograms were compared. Two investigators blinded to the procedure dates analyzed the severity of the lesions using validated quantitative coronary angiography software (QCA).Results: Among 777 patients who underwent PPCI, 458 had multi-vessel disease. Additional angiography to treat non-culprit lesions was performed in 104, of these, 69 patients had a combined total of 74 lesions suitable for QCA analysis. The second angiogram was performed during the same admission (mean 4± 2.7 days) and after discharge (mean 115± 84 days) for 48 and 21 patients, respectively. Compared to PPCI angiograms, the non-PPCI angiograms showed a statistically significant reduction in the percentage of stenosis (71.6± 14.4% vs 64.5± 14.4%, p≤ 0.001), and an increase in minimal luminal diameter (0.82± 0.45 mm vs 1.00± 0.44 mm, p≤ 0.001) of non-culprit lesion. However, no significant difference was observed in the reference diameter (2.89± 0.69 mm vs 2.83± 0.64 mm, p=0.1) of the non-culprit lesion in both angiograms. Furthermore, these differences in the lesion parameters remain constant whether the second angiogram was performed during the same admission or performed after discharge (73.3± 14% and 66.2± 12.9% vs 68.4± 15% and 61.2± 16%, p=0.1).Conclusion: The severity of non-culprit lesion is exaggerated in the PPCI setting. The non-culprit lesion exaggeration remains constant whether the second angiogram was performed early within a few days or later after several weeks.Keywords: acute myocardial infarction, coronary angiogram, minimal lumen diameter, non-culprit lesion, primary percutaneous coronary intervention