Primary percutaneous coronary intervention in acute ST-elevation myocardial infarction: Non-culprit lesions
- J Dawn Abbott, MD, FACC
J Dawn Abbott, MD, FACC
- Associate Professor of Medicine
- Brown Medical School
- Paul Sorajja, MD
Paul Sorajja, MD
- Director, Center for Valve and Structural Heart Disease
- Minneapolis Heart Institute
Coronary artery reperfusion with primary percutaneous coronary intervention, compared with either no reperfusion therapy or fibrinolysis, improves outcomes in patients with acute ST-elevation myocardial infarction (STEMI) if performed in a timely fashion. (See "Acute ST elevation myocardial infarction: Selecting a reperfusion strategy", section on 'Summary and recommendations'.)
Usually, the lesion responsible for the infarct, often referred to as the “culprit lesion,” is readily identified and an attempt is made to re-establish blood flow with the use of thrombectomy, balloon angioplasty, or placement of one or more stents. (See "Primary percutaneous coronary intervention in acute ST elevation myocardial infarction: Periprocedural management".)
In addition to the culprit lesion(s), about 50 percent of STEMI patients have one or more obstructive lesions remote from the area of infarction (ie, "non-culprit" lesions). This topic will address the management of non-culprit lesions in patients with STEMI.
For patients with ST-elevation myocardial infarction who have been referred for primary percutaneous coronary intervention (PCI) and who have had non-culprit lesions identified, we use the following sequential approach:
●We perform primary PCI of the culprit lesion.
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- OUR APPROACH
- IMPACT OF NON-CULPRIT LESIONS
- MANAGEMENT APPROACHES TO NON-CULPRIT LESIONS
- UNANSWERED QUESTIONS
- What is the optimal timing?
- Which non-culprit lesions?
- - Chronic total occlusions
- Who should receive FFR
- RECOMMENDATIONS OF OTHERS
- SOCIETY GUIDELINE LINKS
- SUMMARY AND RECOMMENDATIONS