title: Association of a negative residual stenosis following rescue/adjunctive percutaneous coronary intervention with impaired myocardial perfusion and adverse outcomes among ST-segment elevation myocardial infarction patients.
abstract: OBJECTIVE
  We hypothesized that <0% residual stenosis (RS) after rescue/adjunctive percutaneous coronary intervention (PCI) following fibrinolytic administration in ST-segment elevation myocardial infarction (STEMI) would be associated with improved outcomes.
  
  
  BACKGROUND
  Prior studies have associated larger lumen diameters after PCI with reduced rates of restenosis and target vessel revascularization.
  
  
  METHODS
  Data were drawn from 748 patients with open epicardial arteries and with optimal luminal results (RS <20%) following rescue/adjunctive PCI after fibrinolytic administration in six STEMI trials. Patients were divided into two groups: 1) <0% RS and 2) 0% to 20% RS.
  
  
  RESULTS
  A RS <0% was associated with greater gains in lumen diameter and smaller reference diameters after PCI (p < 0.001 for each), with a trend toward less frequent Thrombolysis In Myocardial Infarction flow grade (TFG) 3. A RS <0% was associated with a greater incidence of abnormal post-PCI Thrombolysis In Myocardial Infarction myocardial perfusion grades (TMPGs) (odds ratio 2.6 [1.2 to 5.9] for TMPG 0/1/2, p = 0.02), even when the analysis was restricted to patients with post-PCI TFG 3.
  
  
  CONCLUSIONS
  A RS <0% following rescue/adjunctive PCI after fibrinolytic therapy for STEMI was independently associated with a reduction in the frequency of normal myocardial perfusion. Potential mechanisms of this finding include greater downstream embolization, increased stimulation of arterial stretch receptors with resultant coronary vasoconstriction, and increased vessel-wall injury after PCI. These findings suggest that additional prospective studies are needed to assess optimal RS that minimizes long-term restenosis without adverse effects.
authors.affiliation: Cardiovascular Division, Beth Israel Deaconess Medical Center, Harvard Medical School, 350 Longwood Avenue, Boston, MA 02115, USA. mgibson@perfuse.org
authors.forename: C Michael
authors.initials: CM
authors.lastname: Gibson
authors.forename: Ajay J
authors.initials: AJ
authors.lastname: Kirtane
authors.forename: Keith
authors.initials: K
authors.lastname: Boundy
authors.forename: Hung
authors.initials: H
authors.lastname: Ly
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Karmpaliotis
authors.forename: Sabina A
authors.initials: SA
authors.lastname: Murphy
authors.forename: Robert P
authors.initials: RP
authors.lastname: Giugliano
authors.forename: Christopher P
authors.initials: CP
authors.lastname: Cannon
authors.forename: Elliott M
authors.initials: EM
authors.lastname: Antman
authors.forename: Eugene
authors.initials: E
authors.lastname: Braunwald
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D017023:Coronary Angiography; D003326:Coronary Circulation / Q000502:physiology*; D023921:Coronary Stenosis / Q000150:complications / Q000000981:diagnostic imaging* / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D012189:Retrospective Studies; D015912:Thrombolytic Therapy; D016896:Treatment Outcome; D014654:Vascular Patency / Q000502:physiology*