Multivessel PCI in STEMI: ready to be the recommended strategy?

Area of Science:

• Cardiology
• Interventional Cardiology
• Acute Myocardial Infarction Management

Background:

• Multivessel obstructive coronary artery disease affects about half of ST-elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI).
• Optimal management of non-culprit lesions in STEMI is debated, leading to practice heterogeneity.
• Current approaches include aggressive, intermediate, and conservative strategies for non-culprit lesion revascularization.

Purpose of the Study:

• To review current evidence on managing non-culprit lesions in STEMI patients with multivessel disease.
• To integrate available data into clinical decision-making for optimal patient outcomes.

Main Methods:

• Review of existing scientific data and post hoc pooled analyses.
• Discussion of the PRAMI study findings and their implications.
• Integration of evidence to inform clinical practice.

Main Results:

• An intermediate approach for non-culprit PCI/CABG is often adopted based on available data.
• The PRAMI study suggests an aggressive approach (PCI during index procedure) improves outcomes compared to a conservative "culprit only" strategy.
• Further research is needed to compare the aggressive approach with the intermediate strategy.

Conclusions:

• Evidence supports considering an intermediate approach for staged non-culprit revascularization.
• The aggressive approach shows promise but requires further comparison with intermediate strategies.
• Clinical decision-making should be guided by the evolving evidence base.