[Importance of severe lesions left untreated in patients with acute coronary syndromes and angioplasty of the culprit lesion].
OBJECTIVE
Patients with acute coronary syndromes may have significantly stenotic nonculprit lesions that do not show complex lesion morphology. We investigated whether these lesions were prone to become unstable since they exist within a prothrombotic and inflammatory systemic milieu.


METHODS
We evaluated the clinical course of 150 patients after successful angioplasty of a culprit lesion: 75 patients with a severely stenotic but uncomplicated nonculprit lesion (group A) and 75 patients without these lesions (group B).


RESULTS
In group A, 1 patient (1.3%) required angioplasty of an initially nonculprit lesion, and in group B, 2 patients (2.6%) died in cardiogenic shock. After 1 year of follow-up, in group A, 4 patients (5.3%) died (cardiac deaths), 1 patient (1.3%) had a myocardial infarction, and 10 patients (13.3%) underwent a repeat revascularization procedure, which in 6 cases (8%) was angioplasty of an initially nonculprit lesion. In all 6 patients with angioplasty of the initially nonculprit lesion, revascularization was done within the first 4 months and was indicated for unstable angina. In group B, 1 patient (1.3%) died (noncardiac death) and 2 patients (2.6%) underwent a repeat revascularization procedure because of restenosis. Survival curves were significantly different between both groups. Belonging to group A was the only independent predictor for events, and within this group location of the lesion in the left anterior descending artery was the main predictor.


CONCLUSIONS
The presence of nonculprit lesions of uncomplicated morphology at the time of a percutaneous revascularization procedure for a culprit lesion in patients with acute coronary syndrome is a short- and middle-term predictor of a moderate rate of recurrent events when these initially innocuous lesions become unstable.
de la Torre Hernández
José M
JM
Unidad de Cardiología Intervencionista. Hospital Universitario Marqués de Valdecilla. Santander. España. hemodinamica@humv.es
Fernández Valls
Mónica
M
González Enríquez
Susana
S
Royuela
Natalia
N
Gómez
Isabel
I
Sáinz
Fermín
F
Cuesta
José María
JM
Zueco
Javier
J
Figueroa
Alvaro
A
Colman
Thierry
T
D000208:Acute Disease; D015906:Angioplasty, Balloon, Coronary; D003327:Coronary Disease / Q000209:etiology* / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013577:Syndrome