Comprehensive Review of Complete Versus Culprit-only Revascularization for Multivessel Disease in ST-segment
Robin Jacob1, Ayaaz K Sachedina2, Sachin Kumar1
1Division of Cardiology, University of Texas Health Science Center at Houston, TX, USA.
Heart International
|October 24, 2022
Summary
For ST-elevation myocardial infarction (STEMI) with multivessel disease, complete revascularization may offer benefits over culprit-only intervention, especially in patients without cardiogenic shock. Optimal strategy is evolving.
Area of Science:
- Cardiology
- Interventional Cardiology
- Acute Coronary Syndromes
Background:
- Management guidelines for ST-segment elevation myocardial infarction (STEMI) exist.
- Optimal revascularization strategy in STEMI with multivessel disease is debated.
- Previous studies favored culprit vessel intervention, but recent trials suggest multivessel approaches may be beneficial.
Purpose of the Study:
- To review and evaluate optimal reperfusion strategies for STEMI patients with multivessel disease.
- To compare culprit vessel-only intervention versus complete revascularization.
- To analyze observational studies, randomized controlled trials, and current guidelines.
Main Methods:
- Literature review and synthesis of existing studies.
- Analysis of data from observational studies and randomized controlled trials.
- Evaluation of current clinical practice guidelines.
Main Results:
- Recent randomized trials suggest potential benefits of multivessel revascularization in STEMI patients without cardiogenic shock.
- Non-culprit lesions can be unstable in acute coronary syndromes.
- Complete revascularization may address diffuse coronary processes.
Conclusions:
- The optimal revascularization strategy for STEMI with multivessel disease is evolving.
- Multivessel revascularization, either immediate or staged, shows promise.
- Clinicians must weigh factors to determine the best approach for individual patients.
Keywords:
ST-segment elevation myocardial infarctionacute coronary syndromecomplete revascularizationculprit vessel-only revascularizationmultivessel revascularizationMore Related Videos
05:26Postconditioning with Lactate-enriched Blood for Cardioprotection in ST-segment Elevation Myocardial Infarction
Published on: May 28, 2019
9.3K
05:41Left Anterior Descending Coronary Artery Ligation for Ischemia-Reperfusion Research: Model Improvement via Technical Modifications and Quality Control
Published on: December 16, 2022
3.6K
Related Concept Videos
01:30Acute Coronary Syndrome I: Introduction
56
Acute Coronary Syndrome (ACS) encompasses a spectrum of heart conditions caused by sudden obstruction of coronary arteries, typically resulting from the rupture of an atherosclerotic plaque and subsequent thrombus (blood clot) formation. This obstruction can lead to partial or complete blockage of blood flow, causing varying degrees of myocardial ischemia or infarction.ACS includes the following clinical entities:Unstable Angina (UA)Non-ST-Elevation Myocardial Infarction (NSTEMI)ST-Elevation...
56
01:30Acute Coronary Syndrome III: Diagnostic Studies
20
Diagnosing acute coronary syndrome or ACS begins with a thorough patient history. Notable symptoms include central, crushing chest pain radiating to the left arm, neck, jaw, or back, along with shortness of breath, sweating (diaphoresis), nausea, vomiting, dizziness, and palpitations.It is crucial to note any history of cardiac illnesses and assess risk factors, including age, gender, smoking, hypertension, diabetes, hyperlipidemia, and a sedentary lifestyle.During physical examination, vital...
20
01:19Acute Coronary Syndrome II: Pathophysiology and Clinical Manifestations
35
The pathophysiology of Acute Coronary Syndrome [ACD] involves several key processes:The main underlying cause of ACD is atherosclerosis, a chronic inflammatory disease characterized by the buildup of lipid-laden plaques within the coronary arteries.As the atherosclerotic plaque grows in the coronary artery, it may become unstable due to the formation of a lipid-rich core and a thin fibrous cap. Inflammatory cells within the plaque, such as macrophages, secrete enzymes that degrade the...
35
01:17Ischemic Heart Disease: Overview
1.4K
Ischemic heart disease occurs when the heart's blood supply dwindles, causing an ominous lack of oxygen and nutrients. This deficiency, stemming from reduced or obstructed blood flow, spells danger, leading to heart muscle damage and dysfunction.
Atherosclerosis, the primary malefactor, orchestrates this dangerous condition. It manifests as the accumulation of fatty deposits, akin to insidious plaques, within arterial walls. As time elapses, these plaques metamorphose, hardening and...
Atherosclerosis, the primary malefactor, orchestrates this dangerous condition. It manifests as the accumulation of fatty deposits, akin to insidious plaques, within arterial walls. As time elapses, these plaques metamorphose, hardening and...
1.4K
01:28Acute Coronary Syndrome IV: Interprofessional Care
22
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...
22
01:27Coronary Artery Disease V: Interprofessional Care
23
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...
23