[Multiple lesions in acute myocardial infarction (AMI) with ST-segment elevation]

The ever-increasing knowledge of the physiopathology involved in acute myocardial infarction (AMI) has allowed improving its treatment. We know now the protagonist role played by intracoronary thrombi in AMI development with ST elevation, which gave rise to the reperfusion concept; in the beginning treated pharmacologically (thrombolytic), followed by direct angioplasty, and at present with a combination of strategies, always emphasizing on the artery responsible for the infarct. Recently, the participation of the inflammatory process has been stressed in its physiopathology, which has widened the therapeutic approach, leading to consider necessarily whether in the acute event only one vessel is involved or the rest of the coronary vessels are being activated simultaneously, i.e., an "acute pan-coronary disease". This, in turn, poses the following question: Should they all be treated? Or should one or several pharmacological measures be taken to inactivate the rest of the arteries and treat them afterwards, resolving only the occluded vessel in the realm of the AMI with ST elevation.