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Morphine and Cardiovascular Outcomes Among Patients With Non-ST-Segment Elevation Acute Coronary Syndromes Undergoing Coronary Angiography The Potential Use of the Index of Microcirculatory Resistance to Guide Stratification of Patients for Adjunctive Therapy in Acute Myocardial Infarction Galectin-3 Levels and Outcomes After Myocardial Infarction: A Population-Based Study Universal Definition of Myocardial Infarction Efficacy and Safety of Stents in ST-Segment Elevation Myocardial Infarction Long-Term Prognostic Implications of Previous Silent Myocardial Infarction in Patients Presenting With Acute Myocardial Infarction Multivessel Versus Culprit-Vessel Percutaneous Coronary Intervention in Cardiogenic Shock TACIT (High Sensitivity Troponin T Rules Out Acute Cardiac Insufficiency Trial): An Observational Study to Identify Acute Heart Failure Patients at Low Risk for Rehospitalization or Mortality Successful catheter ablation of electrical storm after myocardial infarction Cardiac MRI Endpoints in Myocardial Infarction Experimental and Clinical Trials JACC Scientific Expert Panel
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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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