[Immediate multivessel PCI in patients with ACS : Is less more?]

Area of Science:

• Cardiology
• Interventional Cardiology

Background:

• Multivessel coronary artery disease affects a significant proportion of patients with ST-segment elevation myocardial infarction (STEMI) and cardiogenic shock.
• The optimal revascularization strategy following culprit lesion percutaneous coronary intervention (PCI) remains undefined in these patient populations.

Purpose of the Study:

• To summarize current knowledge and data on multivessel revascularization strategies in STEMI and cardiogenic shock.
• To provide recommendations for clinical practice regarding PCI strategies.

Main Methods:

• Review of existing randomized studies comparing multivessel PCI (immediate or staged) versus conservative therapy.
• Analysis of data concerning optimal strategies in patients with cardiogenic shock.
• Discussion of ongoing studies, such as the CULPRIT shock trial.

Main Results:

• Randomized studies show a clinical benefit of multivessel PCI (immediate or staged) over conservative management in STEMI.
• Evidence comparing immediate versus staged PCI is lacking.
• Current data on optimal strategies for cardiogenic shock patients show low concordance.

Conclusions:

• Multivessel PCI offers a clinical benefit compared to conservative therapy in STEMI patients.
• The optimal timing and strategy for multivessel PCI, particularly in cardiogenic shock, require further investigation.
• The CULPRIT shock study is expected to provide crucial insights into optimal strategies for shock patients.