title: Controversies in the treatment of patients with STEMI and multivessel disease: is it time for PCI of all lesions?
abstract: Several randomized trials have suggested a benefit for multivessel PCI in patients with STEMI and multivessel disease. However, none of the studies compared multivessel PCI with a staged PCI-approach which is the current guideline recommended approach. The results of the trials may overestimate the beneficial effect of the multivessel PCI approach because the control group did not receive any ischaemia testing for evaluation of the significance of remaining lesions. Thus, unfavourable aspects of the multivessel PCI approach such as overestimation of non-culprit lesions at the time of acute coronary angiography, complications associated with PCI of the non-culprit lesion (i.e. dissection, no-reflow, acute stent thrombosis) or increased risk for contrast induced nephropathy may have gone unnoticed as the comparative management pathway was unusual and likely inferior to the guideline recommended approach. We believe that culprit lesion only PCI and staged evaluation of remaining areas of myocardial ischaemia with subsequent PCI is still preferable in patients with STEMI and multivessel disease but a randomized study comparing this approach with multivessel PCI is needed.
authors: Department of Cardiology, Robert-Bosch-Krankenhaus, Auerbachstraße 110, 70376, Stuttgart, Germany. peter.ong@rbk.de.
authors: Peter
authors: P
authors: Ong
authors: Department of Cardiology, Robert-Bosch-Krankenhaus, Auerbachstraße 110, 70376, Stuttgart, Germany.
authors: Udo
authors: U
authors: Sechtem
mesh_terms: D003324:Coronary Artery Disease / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*; D019317:Evidence-Based Medicine; D006801:Humans; D018579:Patient Selection; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D000072657:ST Elevation Myocardial Infarction / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D016896:Treatment Outcome
keywords: Culprit lesion; FFR; Multivessel disease; STEMI