Key result
This review highlights the paucity of randomized data comparing multivessel and culprit-only PCI in NSTEMI, advocating for a personalized approach based on patient and lesion-specific factors.
Why the study?
Optimal treatment strategies for multivessel coronary artery disease in NSTEMI are less established than for STEMI, with a paucity of prospective randomized data comparing multivessel and culprit lesion-only PCI.
Does multivessel PCI improve outcomes compared to culprit-only PCI in patients with NSTEMI and multivessel coronary artery disease?
Does multivessel PCI improve outcomes compared to culprit-only PCI in patients with NSTEMI and multivessel coronary artery disease?
This review highlights the lack of robust randomized data for managing multivessel disease in NSTEMI and advocates for a personalized approach to revascularization.
Insufficient randomized data warrants caution with multivessel PCI in NSTEMI; leaves open optimal strategy pending dedicated trials.
Recent analyses suggest the incidence of acute coronary syndrome is declining in high- and middle-income countries. Despite this, overall rates of non-ST-elevation myocardial infarction (NSTEMI) continue to rise. Furthermore, NSTEMI is a greater contributor to mortality after hospital discharge than ST-elevation myocardial infarction (STEMI). Patients with NSTEMI are often older, comorbid and have a high likelihood of multivessel coronary artery disease (MVD), which is associated with worse clinical outcomes. Currently, optimal treatment strategies for MVD in NSTEMI are less well established than for STEMI or stable coronary artery disease. Specifically, in relation to percutaneous coronary intervention (PCI) there is a paucity of randomized, prospective data comparing multivessel and culprit lesion-only PCI. Given the heterogeneous pathological basis for NSTEMI with MVD, an approach of complete revascularization may not be appropriate or necessary in all patients. Recognizing this, this review summarizes the limited evidence base for the interventional management of non-culprit disease in NSTEMI by comparing culprit-only and multivessel PCI strategies. We then explore how a personalized, precise approach to investigation, therapy and follow up may be achieved based on patient-, disease- and lesion-specific factors.
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Baumann et al. (2020) conducted a review in Multivessel coronary artery disease in non-ST-elevation myocardial infarction (NSTEMI). Multivessel PCI vs. Culprit lesion-only PCI was evaluated. This review highlights the paucity of randomized data comparing multivessel and culprit-only PCI in NSTEMI, advocating for a personalized approach based on patient and lesion-specific factors.
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