Partial vs full coverage for tandem lesions in culprit vessel during primary coronary intervention in patients with acute ST-elevation myocardial infarction--the PERFECT-AMI study.

BACKGROUND: The efficacy of partial vs full coverage for tandem lesions in the culprit vessel during primary percutaneous coronary intervention (PCI) after ST-elevation myocardial infarction (STEMI) was compared in the present study.

METHODS AND RESULTS: The 76 patients with STEMI and tandem lesions in the culprit vessel were randomized to receive stent implantation for an occluded/culprit lesion only (partial group) or complete coverage of lesions (full group). After PCI, patients in the partial group had more complete ST-segment resolution (STR) at 90 min (60.5% vs 28.9%, P=0.006), Thrombosis In Myocardial Infarction (TIMI) flow grade 3 (68.4% vs 28.9%, P=0.001), and myocardial blush grade 3 (42.1% vs 15.8%, P=0.04) than those in the full group. At 6 months, the major adverse cardiac events-free survival rate did not differ significantly between groups, but left ventricular (LV) ejection fraction was improved in the partial group. Multivariate analysis revealed pre-procedural TIMI flow grade >1 and door-to-balloon time <90 min were positively associated with complete STR at 90 min, whereas full coverage for tandem lesions was an independent factor for poor STR (odds ratio 2.58, 95% confidence interval 1.08-5.42, P=0.03).

CONCLUSIONS: For acute STEMI patients with tandem lesions in the culprit vessel, primary stenting for the occluded lesion only is beneficial in improving myocardial perfusion and LV function.