title: Nonobstructive coronary disease leading to STEMI:  assessment of residual stenosis after thrombus aspiration.
abstract: OBJECTIVE
  Nonobstructive coronary atherosclerotic lesions can lead to ST-elevation myocardial infarction (STEMI). Thrombus aspiration during a primary percutaneous coronary intervention provides a setting to evaluate the degree of stenosis of culprit lesions leading to STEMI. The aim of this study was to assess the degree of culprit lesion residual stenosis after thrombus aspiration and to compare the demographic, clinical, and angiographic characteristics between patients with obstructive versus nonobstructive residual stenosis.
  
  
  RESULTS
  From a single-center registry of 483 consecutive patients with STEMI undergoing a primary percutaneous coronary intervention, 172 patients underwent thrombus aspiration and were eligible for our study. We defined two groups according to the residual stenosis after thrombus aspiration: group A (n=119, 69%) with residual stenosis greater than or equal to 50%, and group B (n=53, 31%) with residual stenosis less than 50%.In terms of the baseline angiographic characteristics, patients with residual stenosis less than 50% had significantly lower prevalence of multivessel disease (15.1 vs. 46.2%, P<0.001). On multivariable analysis of the preprocedural variables, absence of vascular disease (odds ratio 4.99, 95% confidence interval 1.08-23.12, P=0.040) and age less than 59 years (odds ratio 2.67, 95% confidence interval 1.25-5.73, P=0.011) were independent predictors of culprit residual stenosis less than 50%.
  
  
  CONCLUSIONS
  In this population, a significant proportion of patients with STEMI had nonobstructive residual stenosis after thrombus aspiration. These patients were younger, had a lower prevalence of vascular disease in other vascular territories, and less multivessel disease, suggesting an earlier stage of atherosclerosis.
authors.affiliation: Cardiology Department, Santa Cruz Hospital, West Lisbon Hospital Center, Lisbon, Portugal. paraujogoncalves@yahoo.co.uk
authors.forename: Pedro
authors.initials: P
authors.lastname: De Araújo Gonçalves
authors.forename: João
authors.initials: J
authors.lastname: Brito
authors.forename: Pedro Jeronimo
authors.initials: PJ
authors.lastname: Sousa
authors.forename: Maria Salomé
authors.initials: MS
authors.lastname: Carvalho
authors.forename: Helder
authors.initials: H
authors.lastname: Dores
authors.forename: Rui Campante
authors.initials: RC
authors.lastname: Teles
authors.forename: Luís
authors.initials: L
authors.lastname: Raposo
authors.forename: Henrique Mesquita
authors.initials: HM
authors.lastname: Gabriel
authors.forename: Jorge
authors.initials: J
authors.lastname: Ferreira
authors.forename: Manuel
authors.initials: M
authors.lastname: Almeida
authors.forename: Ana
authors.initials: A
authors.lastname: Aleixo
authors.forename: Miguel Mota
authors.initials: MM
authors.lastname: Carmo
authors.forename: Miguel
authors.initials: M
authors.lastname: Mendes
mesh_terms: D000367:Age Factors; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging; D023921:Coronary Stenosis / Q000000981:diagnostic imaging*; D003328:Coronary Thrombosis / Q000000981:diagnostic imaging / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000453:epidemiology* / Q000628:therapy; D062645:Percutaneous Coronary Intervention; D016491:Peripheral Vascular Diseases / Q000453:epidemiology; D012042:Registries; D012189:Retrospective Studies; D017131:Thrombectomy