Prognostic impact of non-culprit lesion management after myocardial infarction: Insights from a Tunisian cardiac catheterization center

Abstract

Background: 60% of patients with ST-segment elevation myocardial infarction (STEMI) have additional lesions in major epicardial vessels. The debate surrounding the management of non-culprit lesions, including whether and when to revascularize them, remains unresolved. The aim of our study was to investigate the mid-term prognosis of patients with multivessel disease (MVD) based on the initial strategy employed for non-culprit lesion management following STEMI. Results: 150 consecutive patients with STEMI and multi-vessel disease were analyzed. The majority of patients were males (sex ratio of 4.6). High prevalence of dyslipidemia (66.7%) and diabetes (52%) was observed. 10.7% of patients had chronic kidney disease. Most patients had two-vessel disease (56%). The one-year mortality rate was 16%, with higher rates in group 3 (8.7%) and group 1 (6.6%). The group 2 had the lowest mortality rate (0.7%), which was significantly different from the other groups (p=0.003). Over the one-year follow-up, 23 cases of recurrent myocardial infarction were recorded, representing 15.3% of the study population, with varying percentages across the three groups. There was no statistically significant difference among the groups (p=0.135). The median time to reintervention for non-culprit lesions was 10 days. Reintervention beyond 10 days after the initial PCI procedure increased the risk of mortality and/or recurrent infarction, with a hazard ratio of 3.5 (95% CI: 1.06-11.07). There was no statistically significant difference in the risk of contrast-induced nephropathy between patients revascularized before or after ten days. Conclusion: Deferred complete revascularization of non-culprit arteries within ten days appears to be superior to immediate complete revascularization and medical treatment in terms of one-year mortality rates.