PMID- 33839051
OWN - NLM
STAT- MEDLINE
DCOM- 20220325
LR  - 20220325
IS  - 1878-0938 (Electronic)
IS  - 1878-0938 (Linking)
VI  - 35
DP  - 2022 Feb
TI  - Culprit Lesion Detection in Patients Presenting With Non-ST Elevation Acute 
      Coronary Syndrome and Multivessel Disease.
PG  - 110-118
LID - S1553-8389(21)00153-6 [pii]
LID - 10.1016/j.carrev.2021.03.019 [doi]
AB  - BACKGROUND/PURPOSE: Identification of the culprit lesion in patients with non-ST 
      elevation acute coronary syndrome (NSTE-ACS) allows appropriate coronary 
      revascularization but may be unclear in patients with multivessel coronary 
      disease (MVD). Therefore, we investigated the rate of culprit lesion 
      identification during coronary angiography in NSTE-ACS and multivessel disease. 
      METHODS/MATERIALS: Consecutive patients presenting with NSTE-ACS and MVD, between 
      January 2012 and December 2016 were evaluated. Coronary angiograms, intravascular 
      imaging, and ECGs were analyzed for culprit lesion identification. Long-term 
      clinical outcomes in terms of major adverse cardiac events (MACE) and mortality 
      were reported in patients with or without culprit identification. RESULTS: A 
      total of 1107 patients with NSTE-ACS and MVD were included in the analysis, 310 
      (28.0%) with unstable angina and 797 (72.0%) with non-ST elevation myocardial 
      infarction. The culprit lesion was angiographically identified in 952 (86.0%) 
      patients, while no clear culprit lesion was found in 155 (14.0%) patients. ECG 
      analysis allowed to predict the location of the culprit vessel with low 
      sensitivity (range 28.4%-36.7%) and high specificity (range 90.6%-96.5%). Higher 
      lesion complexity was associated with inability to identify the culprit. 
      Intravascular imaging was applied in 55 patients and helped to identify the 
      culprit lesion in 53 patients (96.4%). There was no difference in all-cause 
      mortality (21.4% vs. 25.8%, p = 0.24) and MACE (39.2% vs. 47.6%, p = 0.07) 
      between the cohorts with or without culprit lesion identification by angiography. 
      CONCLUSIONS: The culprit lesion appeared unclear by coronary angiography in >10% 
      of patients with NSTE-ACS and MVD. Complementary invasive imaging substantially 
      enhanced the diagnostic accuracy of culprit lesion detection.
CI  - Copyright (c) 2021 The Authors. Published by Elsevier Inc. All rights reserved.
FAU - Balbi, Matthew Mercieca
AU  - Balbi MM
AD  - Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical 
      Centre, Rotterdam, the Netherlands.
FAU - Scarparo, Paola
AU  - Scarparo P
AD  - Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical 
      Centre, Rotterdam, the Netherlands.
FAU - Tovar, Maria Natalia
AU  - Tovar MN
AD  - Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical 
      Centre, Rotterdam, the Netherlands.
FAU - Masdjedi, Kaneshka
AU  - Masdjedi K
AD  - Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical 
      Centre, Rotterdam, the Netherlands.
FAU - Daemen, Joost
AU  - Daemen J
AD  - Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical 
      Centre, Rotterdam, the Netherlands.
FAU - Den Dekker, Wijnand
AU  - Den Dekker W
AD  - Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical 
      Centre, Rotterdam, the Netherlands.
FAU - Ligthart, Jurgen
AU  - Ligthart J
AD  - Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical 
      Centre, Rotterdam, the Netherlands.
FAU - Witberg, Karen
AU  - Witberg K
AD  - Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical 
      Centre, Rotterdam, the Netherlands.
FAU - Cummins, Paul
AU  - Cummins P
AD  - Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical 
      Centre, Rotterdam, the Netherlands.
FAU - Wilschut, Jeroen
AU  - Wilschut J
AD  - Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical 
      Centre, Rotterdam, the Netherlands.
FAU - Zijlstra, Felix
AU  - Zijlstra F
AD  - Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical 
      Centre, Rotterdam, the Netherlands.
FAU - Van Mieghem, Nicolas M
AU  - Van Mieghem NM
AD  - Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical 
      Centre, Rotterdam, the Netherlands.
FAU - Diletti, Roberto
AU  - Diletti R
AD  - Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical 
      Centre, Rotterdam, the Netherlands. Electronic address: r.diletti@erasmusmc.nl.
LA  - eng
PT  - Journal Article
DEP - 20210330
PL  - United States
TA  - Cardiovasc Revasc Med
JT  - Cardiovascular revascularization medicine : including molecular interventions
JID - 101238551
SB  - IM
CIN - Cardiovasc Revasc Med. 2022 Feb;35:119-120. PMID: 34872847
MH  - *Acute Coronary Syndrome/diagnostic imaging/therapy
MH  - Angina, Unstable/diagnostic imaging/therapy
MH  - Coronary Angiography
MH  - *Coronary Artery Disease/diagnostic imaging/therapy
MH  - Humans
MH  - *Percutaneous Coronary Intervention/methods
MH  - Treatment Outcome
OTO - NOTNLM
OT  - Culprit lesion
OT  - Multivessel coronary artery disease
OT  - Non-ST elevation acute coronary syndrome
OT  - Percutaneous coronary intervention
COIS- Declaration of competing interest None.
EDAT- 2021/04/12 06:00
MHDA- 2022/03/26 06:00
CRDT- 2021/04/11 20:27
PHST- 2020/08/31 00:00 [received]
PHST- 2021/03/05 00:00 [revised]
PHST- 2021/03/17 00:00 [accepted]
PHST- 2021/04/12 06:00 [pubmed]
PHST- 2022/03/26 06:00 [medline]
PHST- 2021/04/11 20:27 [entrez]
AID - S1553-8389(21)00153-6 [pii]
AID - 10.1016/j.carrev.2021.03.019 [doi]
PST - ppublish
SO  - Cardiovasc Revasc Med. 2022 Feb;35:110-118. doi: 10.1016/j.carrev.2021.03.019. 
      Epub 2021 Mar 30.