Culprit-Only vs. Complete Revascularization During ST-Segment Elevation Myocardial Infarction

Prog Cardiovasc Dis. Nov-Dec 2015;58(3):260-6. doi: 10.1016/j.pcad.2015.07.006. Epub 2015 Jul 21.

Abstract

Primary percutaneous intervention (PCI) is the treatment of choice for ST-segment elevation myocardial infarction (STEMI). Patients with STEMI frequently have obstructive non-culprit lesions. In addition, STEMI patients with multivessel disease are at increased risk of major adverse cardiac events. However, current guidelines do not recommend revascularization of non-culprit lesions unless complicated by cardiogenic shock. Prior observational and small randomized controlled trials (RCTs) have demonstrated conflicting results pertaining to the optimal revascularization strategy in STEMI patients with multivessel disease undergoing primary PCI. Recent randomized studies, PRAMI, CvLPRIT, and DANAMI-3-PRIMULTI, provide encouraging data that suggest potential benefit with complete revascularization in STEMI patients with obstructive non-culprit lesions. However, further data from large RCTs are needed to investigate the impact of this strategy on recurrent myocardial infarction/death and to determine the best timing of staged procedures for complete revascularization. Until then, a personalized approach should be taken to optimize the revascularization strategy in STEMI patients with obstructive non-culprit lesions.

Keywords: Complete revascularization; Multivessel disease; PCI; STEMI.

Publication types

  • Review

MeSH terms

  • Coronary Angiography
  • Coronary Artery Disease / diagnosis
  • Coronary Artery Disease / mortality
  • Coronary Artery Disease / therapy*
  • Electrocardiography
  • Humans
  • Myocardial Infarction / diagnosis
  • Myocardial Infarction / mortality
  • Myocardial Infarction / therapy*
  • Patient Selection
  • Percutaneous Coronary Intervention / adverse effects
  • Percutaneous Coronary Intervention / methods*
  • Percutaneous Coronary Intervention / mortality
  • Predictive Value of Tests
  • Randomized Controlled Trials as Topic
  • Risk Assessment
  • Risk Factors
  • Treatment Outcome