title: High-grade culprit lesions are a common cause of ST-segment elevation myocardial infarction.
abstract: BACKGROUND
  Conventional knowledge holds that the majority of ruptured atherosclerotic plaques causing ST-segment elevation myocardial infarction (STEMI) are found in moderate stenoses that produce < 50% loss of arterial diameter. This study aimed to analyse the culprit lesions in patients who presented with STEMI and underwent primary percutaneous coronary intervention (PPCI) at our institution.
  
  
  METHODS
  Patients who underwent PPCI between June 2008 and August 2010 at our institution were included in the analysis. Quantitative coronary angiography was performed for the culprit lesions immediately after antegrade flow was restored by thrombectomy, low-profile balloon predilatation or guidewire crossing.
  
  
  RESULTS
  A total of 1,021 patients were included in the study. The mean age was 57 ± 12 years and 85.2% were male. Lesion measurement was done after coronary flow was restored by thrombectomy (73.1%), balloon dilatation (24.1%) and following guidewire passage across the lesion (2.8%). Mean minimal luminal diameter was 1.1 ± 0.5 mm, mean reference vessel diameter was 2.8 ± 0.6 mm, mean diameter stenosis was 61 ± 16% and mean lesion length was 16 ± 6 mm. Most (80.2%) of the culprit lesions had diameter stenoses > 50% (p < 0.01). Although balloon angioplasty was performed in 24.1% of the patients, the majority (64.2%) still had diameter stenoses > 50%. High-grade stenoses (> 50%) were more frequently observed in male patients (p = 0.04).
  
  
  CONCLUSIONS
  Contrary to the existing paradigm, we found that most of the patients with STEMI in our institution had culprit lesions with diameter stenosis > 50%.
authors.affiliation: National University Heart Centre Singapore, Singapore.
authors.forename: Michael
authors.initials: M
authors.lastname: Liang
authors.affiliation: National University Heart Centre Singapore, Singapore.
authors.forename: Takashi
authors.initials: T
authors.lastname: Kajiya
authors.affiliation: National University Heart Centre Singapore, Singapore.
authors.forename: Mark Y
authors.initials: MY
authors.lastname: Chan
authors.affiliation: National University Heart Centre Singapore, Singapore.
authors.forename: Edgar
authors.initials: E
authors.lastname: Tay
authors.affiliation: National University Heart Centre Singapore, Singapore.
authors.forename: Chi-Hang
authors.initials: CH
authors.lastname: Lee
authors.affiliation: National University Heart Centre Singapore, Singapore.
authors.forename: Arthur Mark
authors.initials: AM
authors.lastname: Richards
authors.affiliation: National University Heart Centre Singapore, Singapore.
authors.forename: Adrian F
authors.initials: AF
authors.lastname: Low
authors.affiliation: National University Heart Centre Singapore, Singapore.
authors.forename: Huay Cheem
authors.initials: HC
authors.lastname: Tan
mesh_terms: D000328:Adult; D000368:Aged; D017130:Angioplasty; D015906:Angioplasty, Balloon, Coronary; D003251:Constriction, Pathologic; D017023:Coronary Angiography; D003331:Coronary Vessels / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention; D058226:Plaque, Atherosclerotic / Q000150:complications; D012016:Reference Values; D012189:Retrospective Studies; D012421:Rupture / Q000150:complications; D000072657:ST Elevation Myocardial Infarction / Q000209:etiology* / Q000601:surgery*; D012737:Sex Factors; D017131:Thrombectomy / Q000379:methods
keywords: acute myocardial infarction; atherosclerosis; coronary artery disease; lesion assessment; percutaneous coronary intervention