title: Managing Multivessel Coronary Artery Disease in Patients With ST-Elevation Myocardial Infarction: A Comprehensive Review.
abstract: Multivessel coronary artery disease (CAD) is found in up to 60% of the patients presenting with an ST-elevation myocardial infarction (STEMI) and worsens the prognosis proportional to the extent of CAD severity. However, the 2013 American College of Cardiology/American Heart Association STEMI guidelines, based on mostly observational data, had recommended against a routine noninfarct-related artery percutaneous coronary intervention (PCI). After these guidelines were published, a handful of randomized trials became available, and they suggested that PCI of significant lesions in a noninfarct-related artery at the time of primary PCI might result in improved patient outcomes. The incidence of major adverse cardiac events was significantly reduced by 55% at 1 year and 65% at 2 years in patients undergoing angiographically guided PCI of nonculprit vessels at the time of primary PCI, in 2 different randomized trials. Fractional flow reserve-guided PCI of nonculprit vessels in this setting has also been shown to reduce cardiac events by 44% at 1 year. Meta-analyses of both nonrandomized and randomized trials have also suggested that complete revascularization at the time of STEMI significantly improves outcomes, including long-term all-cause mortality. In view of the emerging data, a focused update on primary PCI was published in 2015 and suggested that PCI of noninfarct-related arteries might be considered in selected patients. This article is a comprehensive review of the literature on the treatment of multivessel CAD in patients with STEMI, which provides the reader a critical analysis of the available information to determine the best therapeutic approach.
authors.affiliation: From the *Division of Cardiology, Columbia University, Mount Sinai Medical Center, Miami Beach, FL; and †Division of Cardiology, Columbia University Medical Center, New York, NY.
authors.forename: Andrés M
authors.initials: AM
authors.lastname: Pineda
authors.forename: Nikita
authors.initials: N
authors.lastname: Carvalho
authors.forename: Saqib A
authors.initials: SA
authors.lastname: Gowani
authors.forename: Kavit A
authors.initials: KA
authors.lastname: Desouza
authors.forename: Orlando
authors.initials: O
authors.lastname: Santana
authors.forename: Christos G
authors.initials: CG
authors.lastname: Mihos
authors.forename: Gregg W
authors.initials: GW
authors.lastname: Stone
authors.forename: Nirat
authors.initials: N
authors.lastname: Beohar
mesh_terms: D003324:Coronary Artery Disease / Q000150:complications / Q000628:therapy*; D006801:Humans; D009204:Myocardial Revascularization; D062645:Percutaneous Coronary Intervention; D000072657:ST Elevation Myocardial Infarction / Q000209:etiology / Q000628:therapy*