Revascularization strategies in STEMI with multivessel disease: when and how

Acute ST-segment elevation myocardial infarction (STEMI) typically arises from total occlusion of an epicardial coronary artery, most often due to atherosclerotic plaque rupture/erosion and subsequent thrombus formation. Granted this, important angiographic information for patients presenting with STEMI is not only about the status of infarct-related artery (IRA) but also about the atherosclerotic disease burden and disease severity of non-IRA vessels. Previous studies have reported that multivessel coronary artery disease is found in approximately 50% of patients with STEMI undergoing primary percutaneous coronary intervention (PCI). Primary PCI is now considered the gold standard in the treatment for patients with STEMI; however, the optimal reperfusion strategy in patients with STEMI and multivessel disease (MVD) remains uncertain. In this review, we summarize the available evidence on treatment options for patients with STEMI and MVD and highlight current guideline recommendations on this topic.