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

Objective: 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 nonPPCI 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.