Acute coronary syndromes and multivessel coronary artery disease
Giuseppe Zimbardo1, Pio Cialdella1, Paolo Di Fusco1
1Department of Cardiology, Policlinico Casilino, Via Casilina 1049, Rome 00169, Italy.
Insights
Patients with acute coronary syndromes (ACS) and multivessel disease benefit from complete revascularization. Intracoronary imaging may identify vulnerable plaques, improving risk assessment for cardiovascular events.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiovascular Imaging
Background:
- Acute coronary syndromes (ACS) with multivessel coronary artery disease pose high risks for cardiovascular events.
- Complete revascularization reduces major adverse cardiovascular events in STEMI and NSTEMI patients.
- Optimal timing and treatment modality for multivessel disease in ACS remain debated.
Purpose of the Study:
- To review current guideline recommendations for ACS and multivessel disease.
- To explore future perspectives in managing these high-risk patients.
- To highlight the role of intracoronary imaging in identifying vulnerable plaques.
Main Methods:
- Review of current clinical practice guidelines.
- Analysis of existing literature on ACS and multivessel disease management.
- Discussion of intracoronary imaging techniques for plaque assessment.
Main Results:
- Complete revascularization is linked to reduced adverse cardiovascular events.
- Limitations exist in assessing non-culprit lesions based solely on stenosis severity.
- Intracoronary imaging offers potential for identifying high-risk plaques and patients.
Conclusions:
- Further research is needed on optimal intervention timing and modality.
- Intracoronary imaging can enhance risk stratification in ACS patients with multivessel disease.
- Integrating advanced imaging may personalize treatment strategies for better outcomes.
Abstract:
Patients with acute coronary syndromes (ACS) and multivessel coronary artery disease are frequently encountered during clinical practice and those patients are at higher risk of subsequent acute cardiovascular events. In patients presenting with both ST-segment elevation myocardial infarction and non-ST-segment elevation acute coronary syndromes, complete revascularization is associated with decreased risk of major adverse cardiovascular events. Nevertheless, the optimal timing of the intervention and treatment modality are still in discussions. Furthermore, non-culprit lesions assessment based on stenosis severity, either on visual or on functional evaluation, may not provide information about vulnerable plaques prone to thrombosis. Therefore, insights from intracoronary imaging could further identify high-risk plaque and patients at higher risk of future adverse events. This article aims to provide an overview of current guideline recommendations, envisioning future perspectives for the treatment of patients with ACS and multivessel disease.
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