Key result
Staged percutaneous coronary intervention of obstructive non-culprit lesions is the gold standard for STEMI patients with multivessel disease, though optimal timing and assessment remain unresolved.
Why the study?
Optimal timing of staged PCI and the assessment and treatment of intermediate or vulnerable non-culprit lesions in STEMI patients remain unresolved.
This review highlights staged PCI as the gold standard for non-culprit lesions in STEMI while identifying knowledge gaps in timing, physiological assessment, and imaging of vulnerable plaques.
Unresolved questions on non-culprit management in STEMI multivessel disease persist; leaves open optimal timing, selection, and imaging for future RCTs.
Approximately 50% of patients with ST-segment elevation myocardial infarction (STEMI) have multivessel coronary artery disease, a condition associated with an increased incidence of recurrent ischaemic events and higher mortality. Based on recent evidences, a strategy of staged percutaneous coronary intervention (PCI) of obstructive non-culprit lesions should be considered the gold standard for the management of these patients. However, several issues remain still unresolved. Indeed, what is the optimal timing of staged PCI is not completely defined. Moreover, assessment of intermediate non-culprit lesions represent still a clinical conundrum, as pressure-wire indexes do not seem able to correctly identify those patients in whom deferral is safe. Intracoronary imaging may help to identify untreated non-culprit lesions containing vulnerable plaques that may portend a higher risk of future cardiovascular events. However, there are hitherto no studies demonstrating that preventive PCI of vulnerable plaques or more intensive pharmacological treatment is associated with an improved clinical outcome. In this review, we discuss the recent evolving concepts about management of non-culprit plaques in STEMI patients, proposing a diagnostic and therapeutic algorithm to guide physicians in clinical practice. We also underscore the several knowledge gaps to address in future studies.
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Montone et al. (2020) conducted a review in ST-segment elevation myocardial infarction (STEMI) with multivessel coronary artery disease. Staged percutaneous coronary intervention (PCI) was evaluated. Staged percutaneous coronary intervention of obstructive non-culprit lesions is the gold standard for STEMI patients with multivessel disease, though optimal timing and assessment remain unresolved.
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