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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...
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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...
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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...
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Acute Coronary Syndrome II: Pathophysiology and Clinical Manifestations01:19

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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...
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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...
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Cardiac catheterization is an invasive diagnostic technique used to identify and evaluate structural and functional diseases of the heart and major blood vessels. This technique diagnoses congenital heart disease, coronary artery disease, valvular heart disease, and coronary spasms and assesses ventricular function. It helps guide treatment decisions, including the need for revascularization procedures like percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) and...
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Immediate or Deferred Nonculprit-Lesion PCI in Myocardial Infarction.

Robin Nijveldt1, Michael Maeng2,3, Casper W H Beijnink1

  • 1Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands.

The New England Journal of Medicine
|October 29, 2025
PubMed
Summary
This summary is machine-generated.

Immediate iFR-guided PCI for nonculprit lesions in STEMI patients was not superior to deferred MRI-guided PCI. Both strategies showed similar 3-year outcomes for death, heart attack, or heart failure hospitalization.

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Area of Science:

  • Cardiovascular Medicine
  • Interventional Cardiology
  • Diagnostic Imaging

Background:

  • Optimal timing for treating nonculprit lesions in ST-segment elevation myocardial infarction (STEMI) patients is unclear.
  • This study compares immediate percutaneous coronary intervention (PCI) guided by instantaneous wave-free ratio (iFR) versus deferred PCI guided by cardiac stress magnetic resonance imaging (MRI) in STEMI patients with multivessel disease.

Purpose of the Study:

  • To compare the efficacy of immediate iFR-guided PCI versus deferred MRI-guided PCI for nonculprit lesions in STEMI patients.
  • To evaluate the 3-year composite endpoint of death, recurrent myocardial infarction, or heart failure hospitalization.

Main Methods:

  • An international, randomized, controlled trial involving 1146 STEMI patients with multivessel disease.
  • Patients were assigned to immediate iFR-guided PCI (iFR ≤0.89) or deferred MRI-guided PCI within 6 weeks.
  • The primary endpoint was assessed at 3-year follow-up.

Main Results:

  • 42.6% of patients in the iFR group underwent nonculprit lesion PCI versus 18.7% in the MRI group.
  • The primary endpoint occurred in 9.3% of the iFR group and 9.8% of the MRI group (HR, 0.95; 95% CI, 0.65-1.40; P=0.81).
  • No significant difference in serious adverse events between the groups.

Conclusions:

  • Immediate iFR-guided PCI of nonculprit lesions is not superior to deferred MRI-guided PCI in STEMI patients.
  • Both strategies demonstrated comparable 3-year outcomes regarding major adverse cardiovascular events.