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Published on: May 28, 2019
Multi-vessel revascularization in ST-segment elevation myocardial infarction: where do we stand?
Ronald K Binder1, Willibald Maier1, Thomas F Lüscher2
1European Heart Journal, Zurich Heart House, Careum Campus, Moussonstreet 4, 8091 Zurich, Switzerland.
Insights
Current evidence suggests intervention is better than no intervention for coronary artery disease. However, optimal strategies for complete revascularization, including timing and patient selection, require further investigation in future trials.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
Background:
- Assessing the optimal revascularization strategy for patients with coronary artery disease (CAD) is crucial.
- Current evidence supports intervention over conservative management, but specific approaches require clarification.
Discussion:
- The debate between single versus staged complete revascularization persists.
- Optimal timing for staged Percutaneous Coronary Intervention (PCI) remains undetermined, with options including during index admission or delayed within weeks.
Key Insights:
- Intervention generally proves more beneficial than no intervention in CAD.
- Routine, ad-hoc complete revascularization is not recommended.
- Individualized patient and lesion assessment is paramount for treatment decisions.
Outlook:
- Upcoming clinical trials are expected to address the remaining questions regarding complete revascularization strategies.
- Further research will focus on stratifying patients based on evidence of ischemia to guide treatment.
- Personalized approaches will likely shape future guidelines for CAD management.
Abstract:
In summary, current evidence suggests that it appears to be better to do something rather than nothing. However, the question of single vs. staged complete revascularization, the best timing of the staged PCI (during the index admission or within weeks) and the question of stratification for evidence of ischaemia remain to be answered in upcoming trials. Meanwhile, complete revascularization should not be routinely performed ad-hoc, but based on individual and careful patient and lesion assessments
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