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005 Non-invasive stress imaging as a gatekeeper to complete revascularisation in stemi patients with moderate bystander disease at primary percutaneous coronary intervention
  1. Amardeep Ghosh Dastidar1,2,
  2. Angus K Nightingale1,
  3. Thomas W Johnson1,2,
  4. Jonathan CL Rodrigues1,3,
  5. Alexander Carpenter1,
  6. Marco Cengarle1,
  7. Anna Baritussio1,
  8. Elisa McAlindon1,
  9. Daniel X Augustine1,
  10. Gianni Angelini1,2,
  11. Julian Strange1,
  12. Andreas Baumbach1,2,
  13. Chiara Bucciarelli-Ducci1,2
  1. 1NIHR Bristol Cardiovascular Biomedical Research Unit, Bristol Heart Institute, UK
  2. 2School of Clinical Sciences, St Michael’s Hill, University of Bristol
  3. 3School of Physiology and Pharmacology, Medical Sciences Building, University Walk, University of Bristol

Abstract

Introduction 40% of patients presenting with STEMI have multivessel disease (MVD). Current international guidelines recommend revascularisation of the culprit artery only. However recent trials (PRAMI/CVLPRIT) have shown a superiority of complete in-hospital revascularisation. Objective: Assess the role of non-invasive stress imaging as a gatekeeper to complete revascularisation in STEMI patients with moderate bystander disease.

Methods A registry study of consecutive patients who underwent Primary Percutaneous Coronary Intervention (P-PCI) of the culprit artery. Significant MVD was defined as non-culprit stenosis ≥50% in large proximal epicardial vessel, or ≥75% elsewhere (moderate if 50–74% stenosis in large proximal epicardial vessel, or 75–94% elsewhere). Non-invasive stress imaging was performed at 4 weeks. Patients with severe or critical bystander disease were excluded from the study. A simple cost analysis model was built for UK and USA.

Results 1,167 patients were included (74% males, 64 years), 33% demonstrating MVD. 40% of MVD underwent stress CMR, and 36% a stress echocardiogram. The remaining 93 patients underwent direct revascularisation or were lost to follow up. Only 47% had evidence of inducible myocardial ischaemia in moderate bystander coronary artery disease (61/157 in stress CMR and 78/141 in stress echocardiogram). When PCI in MVD is performed only in the presence of inducible myocardial ischemia, there is saving. (UK or US).

Conclusions <50% patients with moderate MVD at PPCI have inducible myocardial ischemia in the moderate bystander disease. Non-invasive stress imaging as a gatekeeper to complete revascularisation, may potentially reduce the number of PCIs, also resulting in a cheaper management strategy.

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