Significance and Prognostic Value of Non-culprit Intermediate Stenosis in Patients Early After Primary Percutaneous Coronary Intervention

Treatment of non-culprit coronary stenosis during primary percutaneous coronary intervention (pPCI) in patients with ST-segment elevation myocardial infarction (STEMI) may be beneficial, but the mode and timing of the intervention are still controversial. The aim of this study was to examine the significance and prognostic value of preserved coronary flow velocity reserve (CFR) by transthoracic Doppler echocardiographic (TDE) imaging in patients with non-culprit intermediate stenosis early after pPCI. The study included 106 patients with residual intermediate (50–70%) non-culprit stenosis after pPCI, who were treated from July 2012 to December 2016 at the Clinic of Cardiology, Clinical Center of Serbia. CFR was performed on a non-infarct-related coronary artery with intermediate stenosis, within 7 days of STEMI, in 96 patients in the left anterior descedenting coronary artery (LAD) and in 10 patients in the right coronary artery (RCA). Cardiac death, acute myocardial infarction, and revascularization of the evaluated vessel were considered adverse events. During a follow-up of 50 ± 17 months, there were 12 adverse events associated with the non-culprit coronary artery. Six of them were in the group of patients with CFR ≤ 2 (total 8 patients) and also 6 in the group with CFR > 2 (total 98 patients). In patients with CFR > 2 of the intermediate non-culprit coronary lesion, deferral of revascularization is associated with an excellent long-term clinical outcome.