title: Risk of no-reflow in culprit lesion versus culprit vessel PCI in acute STEMI.
abstract: OBJECTIVE
  The present report describes patients with acute ST-elevation myocardial infarction who had at least two lesions in the culprit vessel (CV) during primary percutaneous coronary intervention (PCI). Here, we aimed to examine two different strategies, namely, PCI of only culprit lesion (CL) versus PCI of all lesions in the CV in the setting of acute ST-elevation myocardial infarction.
  
  
  METHODS
  Patients who underwent primary PCI were examined for the presence of an additional lesion in the infarct-related artery and divided into two groups according to the PCI strategy: CV versus CL groups. Coronary angiograms were examined for coronary thrombolysis in myocardial infarction (TIMI) flow and major clinical outcomes were determined.
  
  
  RESULTS
  Of 637 patients, 472 (74.1%) underwent primary PCI for the CV (CV group) and 165 (25.9%) underwent primary PCI only for CL (CL group). TIMI flow before primary PCI and after stenting of the CL was similar; however, TIMI flow after completion of the procedure was significantly better in the CL group (P=0.022). The composite of death, nonfatal myocardial infarction and repeat revascularization was significantly better in the CL group (P=0.041) and early stent thrombosis was observed more commonly in the CV group [14 (3.0%) patients vs. 1 (0.6%) patient, P=0.09].
  
  
  CONCLUSIONS
  In the presence of an additional lesion in the CV during primary PCI, deferring stenting for the non-CL in the culprit artery after stenting the CL may be considered to prevent the development of no-reflow or slow-reflow, and thus major clinical adverse events may be reduced.
authors.affiliation: aDepartment of Cardiology, Samsun Education and Research Hospital, Samsun bDepartment of Cardiology, Aydin State Hospital, Aydin, Turkey.
authors.forename: Uğur
authors.initials: U
authors.lastname: Arslan
authors.forename: Mehmet
authors.initials: M
authors.lastname: Yaman
authors.forename: İbrahim
authors.initials: İ
authors.lastname: Kocaoğlu
authors.forename: Oğuzhan Ekrem
authors.initials: OE
authors.lastname: Turan
authors.forename: Huriye
authors.initials: H
authors.lastname: Yücel
authors.forename: Aytekin
authors.initials: A
authors.lastname: Aksakal
authors.forename: İlksen Atasoy
authors.initials: İA
authors.lastname: Günaydin
authors.forename: Ahmet
authors.initials: A
authors.lastname: Hakan Ateş
mesh_terms: D000368:Aged; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D003326:Coronary Circulation; D023903:Coronary Restenosis / Q000209:etiology / Q000503:physiopathology; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000503:physiopathology*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D054318:No-Reflow Phenomenon / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods*; D058226:Plaque, Atherosclerotic; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D015607:Stents; D016896:Treatment Outcome; D014421:Turkey