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Intensive Care Utilization in Stable Patients With ST-Segment Elevation Myocardial Infarction Treated With Rapid Reperfusion Effect of a Restrictive vs Liberal Blood Transfusion Strategy on Major Cardiovascular Events Among Patients With Acute Myocardial Infarction and Anemia: The REALITY Randomized Clinical Trial Dynamic Myocardial Ultrasound Localization Angiography Outcome of Applying the ESC 0/1-hour Algorithm in Patients With Suspected Myocardial Infarction Shock Team Approach in Refractory Cardiogenic Shock Requiring Short-Term Mechanical Circulatory Support: A Proof of Concept Long-term outcomes after myocardial infarction in middle-aged and older patients with congenital heart disease-a nationwide study Effects of clopidogrel vs. prasugrel vs. ticagrelor on endothelial function, inflammatory parameters, and platelet function in patients with acute coronary syndrome undergoing coronary artery stenting: a randomized, blinded, parallel study The Potential Use of the Index of Microcirculatory Resistance to Guide Stratification of Patients for Adjunctive Therapy in Acute Myocardial Infarction Improved Outcomes Associated with the use of Shock Protocols: Updates from the National Cardiogenic Shock Initiative Ticagrelor or Prasugrel in Patients with Acute Coronary Syndromes
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Review Article2017 Aug 24;19(10):93.

JOURNAL：Curr Cardiol Rep. Article Link

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

Patel S, Bailey SR. Keywords: CABG; Complete revascularization; Diabetes; FFR; Multivessel disease; PCI; Physiologic assessment; Primary percutaneous coronary intervention; ST segment elevation myocardial infarction (STEMI); Single vessel; Staged

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. 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.

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