ST-elevation Myocardial Infarction and Multivessel Coronary Artery Disease - A Critical Review of Current Practice,
Filippo Figini1, Shao Liang Chen2, Imad Sheiban1
1Division of Cardiology, Ospedale "Pederzoli", Peschiera del Garda, Italy.
Insights
For ST-elevation myocardial infarction (STEMI) patients with multivessel disease, complete revascularization is recommended. Simple non-culprit lesions can be treated during primary PCI, while complex lesions require individualized timing.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiovascular Medicine
Background:
- Guidelines for ST-elevation myocardial infarction (STEMI) have shifted towards complete revascularization.
- Optimal timing for revascularizing non-culprit lesions in STEMI patients remains debated.
- Multivessel coronary artery disease presents challenges in STEMI management.
Purpose of the Study:
- To offer a practical approach for assessing STEMI patients with multivessel coronary artery disease.
- To analyze randomized trials and meta-analyses on non-culprit lesion revascularization timing.
- To integrate clinical experience into recommendations for complete revascularization strategies.
Main Methods:
- Review of randomized trials and meta-analyses.
- Analysis of clinical experience in managing STEMI with multivessel disease.
- Focus on assessment and timing of percutaneous coronary intervention (PCI) for non-culprit lesions.
Main Results:
- Complete revascularization is generally recommended for STEMI patients.
- Simultaneous multivessel revascularization during primary PCI is suitable for simple non-culprit lesions.
- Complex non-culprit lesions may benefit from deferred, staged PCI, with timing based on clinical judgment.
Conclusions:
- A practical approach to complete revascularization in STEMI with multivessel disease is proposed.
- Individualized timing for staged PCI of complex lesions is crucial.
- This strategy aims to optimize outcomes for STEMI patients undergoing multivessel intervention.
Abstract:
In recent years, practice and guidelines for patients with ST-elevation myocardial infarction (STEMI) have evolved from a 'culprit-only approach' to complete revascularisation; however, several issues remain, particularly regarding assessment of non-culprit lesions and timing of their revascularisation. Complete revascularisation should be performed in patients presenting with STEMI; however, available studies often present contradictory results regarding the optimal timing of non-culprit lesion percutaneous coronary intervention (PCI). The aim of this review is to provide a practical approach for the assessment of patients presenting with STEMI and multivessel coronary artery disease by analysing randomised trials, meta-analyses and our clinical experience. We recommend multivessel revascularisation at the time of primary PCI for simple cases, while we suggest deferring treatment of complex lesions; the optimal timing of staged PCI should be individualised according to clinical judgement.
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