Management of Multivessel Coronary Disease in ST-segment Elevation Myocardial Infarction..pdf (319.79 kB)
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Management of Multivessel Coronary Disease in ST-segment Elevation Myocardial Infarction

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journal contribution
posted on 16.02.2016, 14:05 by Amerjeet S. Banning, Anthony H. Gershlick
Primary PCI of infarct-related arteries is the preferred reperfusion strategy in patients presenting with ST-segment elevation myocardial infarction (STEMI). Up to 40 % of such patients demonstrate evidence of multivessel, non-infarct-related artery coronary disease. Previous non-randomised observational studies and their associated meta-analyses have suggested that in such cases only the culprit infarct-related artery (IRA) lesion should be treated. However, recent randomised controlled trials have demonstrated improved clinical outcomes with lower major adverse cardiovascular events (MACE) rates when complete revascularisation is undertaken either at index primary percutaneous coronary intervention (PPCI) or during index admission. These trials suggest that current guidelines pertaining to treatment of non-infarct-related artery (N-IRA) lesions in STEMI patients with multivessel disease may need to be reconsidered depending on future trials. However, issues remain around timing of N-IRA intervention, the use of fractional flow reserve (FFR) or intravascular imaging to guide intervention in N-IRA lesions and the need to demonstrate reductions in hard clinical endpoints (death and MI) after complete revascularisation; these issues will need to be addressed through future trials. Clinicians must judge on the currently available data, whether it is still safer to leave important stenosis in N-IRA untreated.

History

Citation

Current Cardiology Reports, 2015, 17 (9), pp. 632-?

Author affiliation

/Organisation/COLLEGE OF MEDICINE, BIOLOGICAL SCIENCES AND PSYCHOLOGY/School of Medicine/Department of Cardiovascular Sciences

Version

VoR (Version of Record)

Published in

Current Cardiology Reports

Publisher

Current Medicine Group

issn

1523-3782

eissn

1534-3170

Copyright date

2015

Available date

16/02/2016

Publisher version

http://link.springer.com/article/10.1007/s11886-015-0632-6

Notes

This article is part of the Topical Collection on Management of Acute Coronary Syndromes

Language

en