Background:
In contrast to ST elevation myocardial infarction (STEMI), the identification of the culprit artery in NSTEMI is much more challenging. The aim of current study was to evaluate in NSTEMI patients the possible correlation between the regional wall motion abnormalities (RWMA) distribution as assessed by echocardiography and the identification of the "culprit artery" in the cath lab.
Patients& Methods:
In prospective cohort analysis of 205 NSTEMI consecutive patients who underwent percutaneous coronary Intervention (PCI) at our institution during the last year; age 67.9± 11.7 years, 81% males. RWMA was assessed by echocardiographic examination done prior to or shortly after the index PCI, according to the standard 17 segments supplied by three main epicardial vessels. We looked at the correlation between the RWMA and the culprit vessel, defined as the first target vessel for the PCI procedure as decided by the interventional cardiologist.
Results:
RWMA in patients with NSTEMI were: LAD 51.7%, CX 39% and RCA 56.6%. Multi-vessel distribution was present in 47.3% of patients. PCI was performed for the "culprit artery": LAD-41%, CX-31.2% and RCA-27.8% of the NSTEMI patients. We found a weak correlation between the RWMA and the culprit artery (LAD r=0.1, p=0.1, CX r=0.1, p=0.7 and RCA r=0.2, p=0.002).
Conclusion:
Only weak correlation was found between the RWMA on echocardiographic study and the assumed culprit vessel in NSTEMI patients treated with PCI.
In contrast to STEMI, identification of the "culprit artery" in NSTEMI in the cath lab is much more complex. The extent of multi-vessel disease and the relative ambiguity of NSTEMI on surface ECG may contribute to this discrepancy.
A routine pre-PCI echocardiographic assessment may help to close this gap
