Culprit lesion PCI before diagnostic coronary angiography effectively reduces reperfusion time in STEMI patients: JAMA

A recent study published in the Journal of American Medical Association suggests a new approach to treat patients with ST-elevation myocardial infarction (STEMI) to improve the patient outcomes. The research focused on the timing and sequence of procedures during primary percutaneous coronary intervention (PCI), a critical treatment for STEMI patients to enhance the reperfusion process which is the restoration of blood flow to the heart.

Traditionally, the complete diagnostic coronary angiography (CAG) is performed before addressing the culprit lesion with PCI. However, this study, carried out from April 1, 2021 to August 31, 2022, proposed a radical shift in this sequence. By randomizing 216 patients into two groups, researchers evaluated the effects of performing culprit lesion PCI immediately, before a complete CAG, versus the conventional method of full CAG followed by PCI.

The findings found that the patients who received immediate PCI had significantly shorter needle-to-balloon times and the period from STEMI diagnosis to reperfusion, with an average time of 11.4 minutes when compared to 17.3 minutes in the traditional approach group. Over half of the patients in the immediate PCI group achieved a needle-to-balloon time of 10 minutes or less when compared to only 19.1% in the conventional treatment group.

These results are not just numbers but represent a potential shift in clinical practice that could save lives and reduce the severity of heart damage in STEMI patients. The rapid reperfusion achieved through this innovative approach suggests that immediate identification and treatment of the culprit lesion before conducting a full coronary angiography can significantly enhance the effectiveness of STEMI treatment.

This study reported that the rates of adverse events were similar between the two groups which indicates the accelerated approach does not compromise patient safety. Additionally, there were no significant differences in in-hospital, 30-day and 1-year all-cause mortality rates between the groups that underscore the efficacy and safety of this procedure. While the outcome of this study call for larger trials to validate these promising results and further evaluate the impact on clinical outcomes, this research presents a potential shift in the treatment of STEMI patients.

Source:

Levi, N., Wolff, R., Jubeh, R., Shuvy, M., Steinmetz, Y., Perel, N., Maller, T., Amsalem, I., Hitter, R., Asher, E., Turyan, A., Karmi, M., Orlev, A., Dratva, D., Khoury, Z., Hasin, T., Wolak, A., Glikson, M., & Dvir, D. (2024). Culprit Lesion Coronary Intervention Before Complete Angiography in ST-Elevation Myocardial Infarction. In JAMA Network Open (Vol. 7, Issue 3, p. e243729). American Medical Association (AMA). https://doi.org/10.1001/jamanetworkopen.2024.3729