Complete Revascularization in Patients With STEMI and Multivessel Coronary Artery Disease: Is It Beneficial?

Abstract

Multivessel coronary artery disease is usually present in up to 50% of patients presenting with ST-elevation myocardial infarction (STEMI). The optimal revascularization approach for non-infarct related lesions has been a topic of recent debate. Various observational studies and clinical trials have been conducted to assess the impact of multivessel revascularization. In this review, we aim to present the currently available evidence behind the different revascularization strategies. Early observational studies, registry-based analyses, and meta-analyses had suggested a benefit of culprit only revascularization over complete revascularization. However, in several recent randomized clinical trials, a complete revascularization approach for non-infarct-related lesions, either during the index hospitalization or as a staged approach, has been associated with improved outcomes. These findings exclude patients with cardiogenic shock and chronic total occlusions. Clinical decisions regarding the extent and timing of revascularization in STEMI patients necessitate an individualized, patient-oriented approach. Based on the evidence from recent clinical trials, complete revascularization of non-culprit lesions in STEMI should be considered.