Multivessel revascularization in non-ST-elevation acute coronary syndrome: Should it become the rule in all patients?

An invasive strategy is increasingly used in patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS), especially when the risk of events is intermediate or high.1,2 In confirmed obstructive coronary artery disease, coronary revascularization reduces both mortality and nonfatal events. 1 Around 50% of patients with NSTE-ACS have multivessel disease, and so the type and form of revascularization may require an individualized decision-making process, including discussion in the heart team.1,3 One of the issues facing the care team is whether revascularization of patients with NSTE-ACS and multivessel disease should be incomplete (only the culprit artery) or complete, and in the latter case, whether it should be carried out during the same procedure or in subsequent procedures.There is growing evidence that multivessel revascularization, including of non-culprit lesions, in patients with ST-segment elevation myocardial infarction is safe and reduces the risk of recurrent events.4---6 Although it is tempting to extrapolate these results to the NSTE-ACS patient population, it is important to note that there have been no prospective randomized tri-