Revascularization Strategies in STEMI with Multivessel Disease: Deciding on Culprit Versus Complete—Ad Hoc or Staged

Shalin Patel, Steven R Bailey

Research output: Contribution to journalReview articlepeer-review

3 Scopus citations

Abstract

Purpose of Review: This review will address the clinical conundrum of those who may derive clinical benefit from complete revascularization of coronary stenosis that are discovered at the time of ST segment elevation myocardial infarction (STEMI). The decision to revascularize additional vessels with angiographic stenosis beyond the culprit lesion remains controversial, as does the timing of revascularization. Recent Findings: STEMI patients represent a high-risk patient population that have up to a 50% prevalence of multivessel disease. Multivessel disease represents an important risk factor for short- and long-term morbidity and mortality. Potential benefits of multivessel PCI for STEMI might include reduced short- and long-term mortality, revascularization, reduced resource utilization, and costs. Which population will benefit and what the optimal timing of revascularization in the peri-MI period remains controversial. Summary: Consideration of multivessel revascularization in the setting of STEMI may occur in up to one half of STEMI patients. Evaluation of the comorbidities including diabetes, extent of myocardium at risk, lesion complexity, ventricular function, and risk factors for complications such as contrast induced nephropathy which is important in determining the appropriate care pathway.

Original languageEnglish (US)
Article number93
JournalCurrent Cardiology Reports
Volume19
Issue number10
DOIs
StatePublished - Oct 1 2017

Keywords

  • CABG
  • Complete revascularization
  • Diabetes
  • FFR
  • Multivessel disease
  • PCI
  • Physiologic assessment
  • Primary percutaneous coronary intervention
  • Single vessel
  • ST segment elevation myocardial infarction (STEMI)
  • Staged

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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