1. Nat. Rev. Cardiol. doi:10.1038/nrcardio.2017.88
Figure 6 Decision process and reperfusion options in patients with STEMI and multivessel disease
Figure 6 | Decision process and reperfusion options in patients with STEMI and multivessel disease. When patients with ST-segment elevation myocardial infarction (STEMI) have multivessel disease, several factors should be taken into account for determining the optimal reperfusion strategy for nonculprit lesions. Complex coronary interventions resulting in long procedural time and substantial contrast load might argue against additional percutaneous coronary intervention (PCI) of nonculprit lesions during the index PCI. In addition, patient clinical characteristics, including haemodynamic instability, renal failure, or age, might prompt one or another treatment strategy. So far, results of eight randomized controlled trials (in blue) to compare different treatment strategies have been reported. In three of the trials, fractional flow reserve (FFR) was used to guide preventive PCI in nonculprit lesions. A strategy of FFR-guided staged PCI for nonculprit lesions is also included in the ongoing COMPLETE trial106 (in green), which will be the first randomized controlled trial with the statistical power to detect differences in the rates of death or myocardial infarction between treatment strategies. If complete revascularization is superior to optimal medical therapy alone, further large randomized controlled trials might be needed to clarify the role of multivessel primary PCI, evaluate the option of surgical revascularization, and determine the value of a strategy including routine stress testing.
Vogel, B. et al. (2017) Reperfusion strategies in acute myocardial infarction and multivessel disease
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