Related Experiment Video

Updated: Mar 12, 2026

Interventional Diagnostic Procedure: A Practical Guide for the Assessment of Coronary Vascular Function
10:28

Interventional Diagnostic Procedure: A Practical Guide for the Assessment of Coronary Vascular Function

Published on: March 15, 2022

6.1K

Pathfinding to an optimal strategy of revascularization in primary coronary intervention in patients with multivessel

András Komócsi1, Dániel Kehl2, Fabrizio d'Ascenso3

  • 1a University of Pécs, Heart Institute , Department of Interventional Cardiology , Pécs , Hungary.

Current Medical Research and Opinion
|November 17, 2016
PubMed

Insights

Complete revascularization, including immediate or staged treatment of non-culprit lesions, significantly reduces major adverse cardiac events in ST-segment elevation myocardial infarction (STEMI) patients compared to culprit-only intervention.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Clinical Trials

Background:

  • Current guidelines for ST-segment elevation myocardial infarction (STEMI) recommend against treating non-culprit lesions during primary intervention.
  • Emerging trial data suggest potential benefits of early complete revascularization in STEMI patients.

Purpose of the Study:

  • To compare culprit-only intervention with different timings of multivessel revascularization in STEMI patients.
  • To evaluate the efficacy of immediate (IM), same hospitalization (SH), and later staged (ST) revascularization strategies versus culprit-only (CO) approach.

Main Methods:

  • A Bayesian multiple treatment network meta-analysis of randomized clinical trials (RCTs) was conducted.
  • Eight RCTs involving 2077 patients were analyzed using a random-effects model and Bayesian Markov chain Monte Carlo methods.

Main Results:

  • Both staged (ST) and immediate (IM) revascularization reduced major adverse cardiac events (MACEs) compared to culprit-only (CO) intervention (RR: 0.43 and 0.36, respectively).
  • Immediate revascularization (IM) was superior to same hospitalization (SH) for MACEs (RR: 0.49) and myocardial infarction (RR: 0.18).
  • IM had a 71.2% probability of being the optimal treatment for reducing MACEs, followed by ST (28.5%).

Conclusions:

  • Immediate or staged revascularization of non-culprit lesions in STEMI patients reduces major adverse events post-primary percutaneous coronary intervention.
  • While immediate or staged interventions appear superior, further RCTs are necessary to establish the optimal timing for non-culprit lesion revascularization.
Abstract

Keywords:
CulpritST-segment elevation myocardial infarctionmeta-analysismultivesseloutcomesprimary percutaneous intervention

More Related Videos

Direct Re-implantation of Left Coronary Artery into the Aorta in Adults with Anomalous Origin of Left Coronary Artery from the Pulmonary Artery ALCAPA13:10

Direct Re-implantation of Left Coronary Artery into the Aorta in Adults with Anomalous Origin of Left Coronary Artery from the Pulmonary Artery ALCAPA

Published on: April 24, 2017

19.4K
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke09:21

Optimized Management of Endovascular Treatment for Acute Ischemic Stroke

Published on: January 18, 2018

12.7K

Related Concept Videos

Coronary Artery Disease V: Interprofessional Care01:27

Coronary Artery Disease V: Interprofessional Care

Interprofessional care for coronary artery disease includes pharmacological therapy and revascularization procedures.Pharmacological therapy for Coronary Artery Disease (CAD) aims to manage symptoms, prevent complications, and improve patient outcomes through various classes of medications:Antiplatelet Agents:Aspirin and Clopidogrel: These medications inhibit platelet aggregation, preventing blood clots, which is crucial for avoiding heart attacks and strokes. Doctors often prescribe these...
357
Acute Coronary Syndrome IV: Interprofessional Care01:28

Acute Coronary Syndrome IV: Interprofessional Care

IntroductionThe management of Acute Coronary Syndrome (ACS) aims to minimize myocardial damage, preserve myocardial function, and prevent complications.Initial ManagementInpatient management involves continuous cardiac monitoring, preferably in an ICU, focusing on blood pressure, serum sodium, potassium, and creatinine levels, and urine output. Ongoing pharmacologic management is crucial for stabilizing the patient.Supplemental Oxygen: Administer supplemental oxygen if oxygen saturation is...
374
Atherosclerosis III: Management01:26

Atherosclerosis III: Management

Management of atherosclerosis involves an integrated strategy encompassing pharmacological treatment, surgical interventions, lifestyle changes, and nutrition therapy to address the multifactorial nature of the disease.Pharmacological TherapyA cornerstone of atherosclerosis management is the use of pharmacological agents. Statins, such as atorvastatin, are pivotal in inhibiting HMG-CoA reductase, an enzyme that catalyzes an initial step in cholesterol synthesis in the liver. This reduction in...
541
Angina IV: Management01:26

Angina IV: Management

IntroductionThe management of angina requires a comprehensive approach that includes pharmacological therapies, medical procedures, and lifestyle modifications.Pharmacological TherapiesAntiplatelet agents, such as aspirin, clopidogrel, prasugrel, and ticagrelor, play a pivotal role in preventing thrombus formation in patients with angina. These medications inhibit platelet aggregation and reduce the likelihood of myocardial infarction and other cardiovascular events.Anticoagulants, including...
372
Peripheral Artery Disease III: Interprofessional Care01:27

Peripheral Artery Disease III: Interprofessional Care

Peripheral Artery Disease (PAD) is characterized by narrowed arteries that diminish blood flow to the extremities. Effective management of PAD requires an interprofessional approach involving various healthcare professionals. The critical aspects of interprofessional care for PAD patients focus on risk factor modification, drug therapy, exercise therapy, nutrition therapy, critical limb ischemia care, and interventional radiology and surgical procedures.The primary treatment goal for PAD...
486
Coronary Artery Disease IV: Preventive Measures01:26

Coronary Artery Disease IV: Preventive Measures

Effective preventive measures for coronary artery disease (CAD) focus on controlling modifiable risk factors, including cholesterol abnormalities and lifestyle changes.Cholesterol ManagementFirst, the Mediterranean diet and the American Heart Association advocate for maintaining low-density lipoprotein (LDL) cholesterol levels below 100 mg/dL, with a more stringent recommendation of below 70 mg/dL for individuals at high risk. LDL cholesterol, often termed "bad cholesterol," can lead to the...
790