Modern day cardiac scientists have legally defined a significant coronary lesion as > 70 % obstruction. Unfortunately this rule is applicable more in academic forums not in cath labs.
While the guidelines seem to be clear in chronic coronary syndromes , in ACS the interventional strategies based on severity of lesion is not clearly defined.
Many times in a recannalised coronary artery following STEMI (Either spontaneous or pharmacological ) even a 10-20 % lesion is stented .(Mind you , coronary erosion that trigger pure thrombotic STEMI will be stented by most of the proud young cardiologists of today !) The guidelines conveniently ignore this area allowing the cardiac physicians to indulge in the coronary exotica !
Is this logical ?
Why do you need to stent a successfully lysed coronary lesion with TIMI 3 flow. ?(We do know , many young infarcts have pure thrombotic STEMI with zero % lesion (In India 40% of young STEMI has near normal CAG )
This situation arises by an ill conceived concept called pharmaco- invasive approach where routine coronary angiogram is advocated even after successful thrombolysis in patient who is asymptomatic and complete salvage of myocardium has been achieved by pharmacological means .
* The only way to prevent this excess is to ban the pharmaco -Invasive approach for asymptomatic and apparently successful thrombolysis .(Better still even CAG should be banned ! for the simple reason an inappropriate CAG begets an Inappropriate PCI !)
A Narrow gap separates Ignorance and knowledge !
Does the PCI makes the ill-fated site less vulnerable for future events . . . when compared to well re-cannlised native coronary artery with negligible lesion ?
The funny side of cardiac science can be appreciated , when somebody is implanting a latest generation stent for 10-20 % lesion just because it is associated with an ACS , another would astutely study the significance of 70-80% lesion by FFR in an adjacent lab !
Dr.S.Venkatesan MD 