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Updated: May 23, 2026

Interventional Diagnostic Procedure: A Practical Guide for the Assessment of Coronary Vascular Function
Published on: March 15, 2022
Multivessel disease in primary percutaneous coronary intervention
1Humanitas Clinical Institute, IRCCS, Milan, Italy. guido.belli@humanitas.it
Insights
Percutaneous coronary intervention (PCI) is standard for acute myocardial infarction (AMI). Treating multivessel disease during primary PCI is complex, impacting long-term cardiac events and mortality.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiovascular Disease
Background:
- Primary percutaneous coronary intervention (PCI) is the standard treatment for acute transmural myocardial infarction (AMI).
- Approximately 50% of AMI patients present with multivessel (MV) coronary artery disease.
- MV disease in AMI is linked to negative prognostic factors and increased long-term mortality.
Purpose of the Study:
- To review clinical data on the treatment of MV coronary artery disease diagnosed during primary PCI for AMI.
- To discuss the challenges in decision-making for treating non-culprit lesions in AMI.
- To summarize current understanding of early atherosclerosis progression post-AMI.
Main Methods:
- Review of available clinical data and studies.
- Analysis of prognostic factors associated with MV disease in AMI.
- Examination of short-term atherosclerosis progression after AMI.
Main Results:
- Multivessel coronary artery disease in AMI patients is associated with adverse cardiac events and increased mortality.
- Treatment of non-culprit lesions during primary PCI presents a complex clinical decision.
- Understanding of early atherosclerosis progression after AMI is crucial for management.
Conclusions:
- The management of multivessel coronary artery disease in the context of primary PCI for AMI requires careful consideration.
- Further research is needed to optimize treatment strategies for these complex patients.
- Addressing non-culprit lesions may impact long-term outcomes in AMI survivors.
Abstract:
Primary percutaneous coronary intervention (PCI) is currently the preferred revascularization strategy in acute trasmural myocardial infarction (AMI). In this setting, about one half of patients will be diagnosed with concomitant multivessel (MV) coronary artery disease, associated with a multitude of negative prognostic factors but also still an independent predictor of adverse cardiac events and increased long-term mortality. Since additional "angiographic" lesions found at primary PCI are not directly responsile for the acute presentation, their treatment represents a difficult decision-making problem in cardiology. The article summarizes available clinical data on treatment in this setting and also review our current understanding of short-term progression of atherosclerosis after AMI.
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