Key result
Complete revascularization in STEMI patients with multivessel disease significantly reduces the need for future unplanned revascularizations, although no trial has demonstrated a significant mortality benefit.
Why the study?
Up to 50% of STEMI patients have multivessel coronary artery disease, but conflicting data exist regarding the optimal revascularization strategy and timing in these patients.
Does complete revascularization reduce the need for future unplanned procedures in patients with STEMI and multivessel coronary artery disease?
Does complete revascularization reduce the need for future unplanned procedures in patients with STEMI and multivessel coronary artery disease?
Complete revascularization may benefit stable STEMI patients with multivessel disease by reducing future unplanned procedures, whereas unstable patients should receive culprit-only treatment during the index procedure.
Answers are grounded in this paper and cite their sources.
Supports complete revascularization to reduce unplanned procedures in multivessel STEMI; leaves open mortality benefit.
Atherosclerosis is the most common cause of coronary steno-occlusive disease and acute myocardial infarction is the leading cause of death in industrialized countries. In patients with acute ST elevation myocardial infarction (STEMI), there is unquestionable evidence that primary percutaneous coronary intervention providing recanalization of the infarct related artery (IRA) is the preferred reperfusion strategy. Nevertheless, up to 50% of patients with STEMI have multivessel coronary artery disease defined as at least 50% stenosis exclusive of IRA. There is conflicting data regarding the optimal treatment strategy and timing in such patients. Currently, it is assumed that stable patients might benefit from complete revascularization particularly in reducing the need for future unplanned procedures but only culprit lesion should be treated during index procedure in unstable patients. In this article, we provide a comprehensive overview of this important and currently highly debated topic.
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Špaček et al. (2022) conducted a review in ST elevation myocardial infarction (STEMI) with multivessel coronary artery disease. Complete revascularization vs. Culprit-lesion-only percutaneous coronary intervention was evaluated. Complete revascularization in STEMI patients with multivessel disease significantly reduces the need for future unplanned revascularizations, although no trial has demonstrated a significant mortality benefit.
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