Key result
Complete revascularization is superior to culprit-artery revascularization only in hemodynamically stable patients with STEMI and multivessel disease, though optimal timing should be individualized.
Why the study?
Available studies present contradictory results regarding the optimal timing of non-culprit lesion PCI and assessment in STEMI with multivessel disease.
Does complete multivessel revascularization improve clinical outcomes compared to culprit-only PCI in patients presenting with ST-elevation myocardial infarction and multivessel coronary artery disease?
Does complete multivessel revascularization improve clinical outcomes compared to culprit-only PCI in patients presenting with ST-elevation myocardial infarction and multivessel coronary artery disease?
Complete revascularization is recommended over culprit-only PCI in hemodynamically stable STEMI patients with multivessel disease, with the timing of staged PCI individualized according to lesion complexity.
Supports complete revascularization in stable STEMI multivessel disease; leaves open optimal timing and generalizability pending prospective trials.
In recent years, practice and guidelines for patients with ST-elevation myocardial infarction (STEMI) have evolved from a 'culprit-only approach' to complete revascularisation; however, several issues remain, particularly regarding assessment of non-culprit lesions and timing of their revascularisation. Complete revascularisation should be performed in patients presenting with STEMI; however, available studies often present contradictory results regarding the optimal timing of non-culprit lesion percutaneous coronary intervention (PCI). The aim of this review is to provide a practical approach for the assessment of patients presenting with STEMI and multivessel coronary artery disease by analysing randomised trials, meta-analyses and our clinical experience. We recommend multivessel revascularisation at the time of primary PCI for simple cases, while we suggest deferring treatment of complex lesions; the optimal timing of staged PCI should be individualised according to clinical judgement.
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Figini et al. (2020) conducted a review in ST-elevation myocardial infarction (STEMI) and multivessel coronary artery disease. Complete revascularisation (multivessel PCI) vs. Culprit-lesion only PCI (IRA-only) was evaluated. Complete revascularization is superior to culprit-artery revascularization only in hemodynamically stable patients with STEMI and multivessel disease, though optimal timing should be individualized.
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