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Percutaneous coronary intervention strategies in patients with ST-segment elevation myocardial infarction and

Michael P Thomas1, Eric R Bates

  • 1Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan Medical Center, Ann Arbor, Michigan, USA.

Current Opinion in Cardiology
|August 1, 2017
PubMed

Insights

Percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI) with multivessel coronary artery disease (CAD) shows multivessel PCI is beneficial. Guidelines now recommend it for select patients, though further trials are needed.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Cardiovascular Research

Background:

  • ST-elevation myocardial infarction (STEMI) with multivessel coronary artery disease (CAD) presents complex treatment challenges.
  • Optimal revascularization strategies for STEMI patients with multivessel CAD are evolving.
  • Current guidelines are being updated based on recent clinical evidence.

Purpose of the Study:

  • To review and synthesize recent findings on percutaneous coronary intervention (PCI) strategies for STEMI patients with multivessel CAD.
  • To evaluate the efficacy of multivessel PCI compared to culprit-lesion-only PCI in this patient population.
  • To assess the role of functional assessment (e.g., fractional flow reserve) in guiding PCI decisions.

Main Methods:

  • Review of recent randomized clinical trials and meta-analyses.
  • Analysis of guideline updates and clinical practice recommendations.
  • Examination of data on the impact of PCI strategies on mortality, myocardial infarction, and left ventricular function.

Main Results:

  • Multivessel PCI (primary or staged) appears more beneficial than culprit vessel-only PCI in STEMI patients with multivessel CAD.
  • Clinical guidelines now suggest considering multivessel PCI in hemodynamically stable patients with significant noninfarct stenoses.
  • Fractional flow reserve-guided PCI has not demonstrated improved mortality or myocardial infarction rates.
  • PCI of non-culprit artery chronic total occlusions did not improve left ventricular function in one trial.

Conclusions:

  • Multivessel PCI is effective and safe in selected STEMI patients with multivessel CAD.
  • Further research is required to determine optimal timing and selection criteria for multivessel PCI.
  • The role of PCI for non-culprit stenoses requires further investigation.
Abstract

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