title: A contemporary re-evaluation of culprit lesion severity in patients presenting with STEMI.
abstract: BACKGROUND
  Historical data report fatal myocardial infarction occurring when mildly-stenotic coronary plaques rupture; however, recent data suggest haemodynamically-significant coronary stenoses with fractional flow reserve (FFR) ≤ 0.8 and vessels with high plaque burden and minimum luminal area (MLA) < 4 mm(2) by intravascular ultrasound (IVUS) may be prognostically important. Therefore, we sought to re-evaluate culprit stenosis severity in patients presenting with ST-segment elevation myocardial infarction (STEMI).
  
  
  METHODS
  Patients undergoing primary percutaneous coronary intervention (PPCI) for STEMI with adjunctive thrombectomy between October 2008 and February 2010 (n = 336/572; 59%) underwent quantitative coronary angiography (QCA) after thrombus aspiration to determine vessel reference area (RA), MLA and percentage area stenosis (AS). To validate findings, QCA and FFR were measured in 50 patients with stable angina and an angiographically-intermediate lesion.
  
  
  RESULTS
  STEMI patients had anatomically-severe underlying culprit disease similar to that of the stable cohort (AS: 91.6 ± 9.5% versus 90.1 ± 8.1%; P = 0.11). Additionally, anatomically-severe lesions defined by QCA were more likely to be functionally-significant by FFR and vice-versa (P = 0.02 and 0.002 respectively).
  
  
  CONCLUSIONS
  These contemporary data suggest that STEMI culprit lesions, defined by luminal stenosis after thrombus aspiration, are angiographically significant, with similar stenosis severity to stable, ischaemia-inducing lesions.
authors.affiliation: Department of Interventional Cardiology, Papworth Hospital, Cambridge, UK.
authors.forename: Liam M
authors.initials: LM
authors.lastname: McCormick
authors.forename: Stephen P
authors.initials: SP
authors.lastname: Hoole
authors.forename: Adam J
authors.initials: AJ
authors.lastname: Brown
authors.forename: David P
authors.initials: DP
authors.lastname: Dutka
authors.forename: Nick E J
authors.initials: NE
authors.lastname: West
mesh_terms: D015906:Angioplasty, Balloon, Coronary; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000473:pathology*; D003328:Coronary Thrombosis / Q000601:surgery; D003331:Coronary Vessels / Q000473:pathology*; D005260:Female; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000473:pathology* / Q000628:therapy; D058226:Plaque, Atherosclerotic / Q000000981:diagnostic imaging / Q000473:pathology* / Q000503:physiopathology; D017131:Thrombectomy; D018084:Ultrasonography, Interventional