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Low-Dose Aspirin Discontinuation and Risk of Cardiovascular Events: A Swedish Nationwide, Population-Based Cohort Study Targeting the Immune System in Atherosclerosis: JACC State-of-the-Art Review Door to Balloon Time: Is There a Point That Is Too Short? Nonculprit Stenosis Evaluation Using Instantaneous Wave-Free Ratio in Patients With ST-Segment Elevation Myocardial Infarction Bare metal versus drug eluting stents for ST-segment elevation myocardial infarction in the TOTAL trial Comparison of Outcomes of Patients With ST-Segment Elevation Myocardial Infarction Treated by Primary Percutaneous Coronary Intervention Analyzed by Age Groups (<75, 75 to 85, and >85 Years); (Results from the Bremen STEMI Registry) Location of the culprit coronary lesion and its association with delay in door-to-balloon time (from a multicenter registry of primary percutaneous coronary intervention) Volume brings value Percutaneous coronary intervention reduces mortality in myocardial infarction patients with comorbidities: Implications for elderly patients with diabetes or kidney disease Remote ischaemic conditioning and healthcare system delay in patients with ST-segment elevation myocardial infarction
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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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