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Reperfusion strategies in acute myocardial infarction and multivessel disease

Birgit Vogel1, Shamir R Mehta2, Roxana Mehran1

  • 1Icahn School of Medicine at Mount Sinai, The Zena and Michael A. Wiener Cardiovascular Institute, One Gustave L. Levy Place, Box 1030, New York, New York 10029, USA.

Nature Reviews. Cardiology
|June 30, 2017
PubMed

Insights

For ST-elevation myocardial infarction (STEMI) patients with multivessel disease, optimal reperfusion strategy remains unclear. This review summarizes evidence comparing culprit-only versus complete revascularization, guiding future treatment directions.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Clinical Medicine

Background:

  • Multivessel disease affects approximately 50% of ST-elevation myocardial infarction (STEMI) patients.
  • Optimal reperfusion strategy in STEMI patients with multivessel disease is uncertain.
  • Current debate centers on culprit-vessel-only percutaneous coronary intervention (PCI) versus complete revascularization (simultaneous or staged PCI).

Purpose of the Study:

  • To comprehensively review current evidence on treatment options for STEMI patients with multivessel disease.
  • To highlight current guideline recommendations for reperfusion strategies.
  • To provide future directions for managing STEMI and multivessel disease.

Main Methods:

  • Review of observational studies and randomized controlled trials.
  • Analysis of clinical outcomes associated with different PCI strategies.
  • Evaluation of evidence regarding safety and efficacy of multivessel PCI.

Main Results:

  • Observational studies often suggest worse outcomes with multivessel PCI.
  • Randomized controlled trials indicate multivessel PCI is safe and can reduce re-PCI needs in selected STEMI patients.
  • Further adequately-powered studies are needed to confirm reduction in hard endpoints like death or myocardial infarction.

Conclusions:

  • The optimal reperfusion strategy for STEMI patients with multivessel disease requires further investigation.
  • Multivessel PCI may be beneficial in selected patients, but definitive evidence on hard endpoints is pending.
  • Future research should focus on large-scale trials to guide treatment decisions and improve patient outcomes.

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