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Review
. 2023 Mar 29;12(7):2572.
doi: 10.3390/jcm12072572.

Management of Non-Culprit Lesions in STEMI Patients with Multivessel Disease

Raffaele Piccolo  1 , Lina Manzi  1 , Fiorenzo Simonetti  1 , Attilio Leone  1 , Domenico Angellotti  1 , Maddalena Immobile Molaro  1 , Nicola Verde  1 , Plinio Cirillo  1 , Luigi Di Serafino  1 , Anna Franzone  1 , Carmen Anna Maria Spaccarotella  1 , Giovanni Esposito  1
Affiliations
Review

Management of Non-Culprit Lesions in STEMI Patients with Multivessel Disease

Raffaele Piccolo et al. J Clin Med. .

Abstract

Multivessel disease is observed in approximately 50% of patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). Data from randomized clinical trials has shown that complete revascularization in the STEMI setting improves clinical outcomes by reducing the risk of reinfarction and urgent revascularization. However, the timing and modality of revascularization of non-culprit lesions are still debated. PCI of non-culprit lesions can be performed during the index primary PCI or as a staged procedure and can be guided by angiography, functional assessment, or intracoronary imaging. In this review, we summarize the available evidence about the management of non-culprit lesions in STEMI patients with or without cardiogenic shock.

Keywords: STEMI; complete revascularization; culprit lesion; multivessel disease; myocardial infarction; non-culprit coronary lesion.

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Conflict of interest statement

Dr. Esposito reports personal fees from Abbott Vascular, Amgen, Boehringer Ingelheim, Edwards Lifesciences, Terumo, and Sanofi outside the submitted work and research grants to the institution from Alvimedica, Boston Scientific, and Medtronic. Dr. Piccolo reports personal fees from Abbott Vascular, Biotronik, Terumo, Amgen, Boehringer Ingelheim, and Daiichi-Sankyo outside the submitted work. The other authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Treatment algorithm.
See this image and copyright information in PMC

References

    1. O’Gara P.T., Kushner F.G., Ascheim D.D., Casey D.E., Jr., Chung M.K., de Lemos J.A., Ettinger S.M., Fang J.C., Fesmire F.M., Franklin B.A., et al. 2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction: Executive Summary A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation. 2013;127:529–555. doi: 10.1161/CIR.0b013e3182742c84. - DOI - PubMed
    1. Levine G.N., Bates E.R., Blankenship J.C., Bailey S.R., Bittl J.A., Cercek B., Chambers C.E., Ellis S.G., Guyton R.A., Hollenberg S.M., et al. 2015 ACC/AHA/SCAI Focused Update on Primary Percutaneous Coronary Intervention for Patients with ST-Elevation Myocardial Infarction An Update of the 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention and the 2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction a Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Society for Cardiovascular Angiography and Interventions. Circulation. 2016;133:1135–1147. - PubMed
    1. Ibanez B., James S., Agewall S., Antunes M.J., Bucciarelli-Ducci C., Bueno H., Caforio A.L.P., Crea F., Goudevenos J.A., Halvorsen S., et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC) Eur. Heart J. 2018;39:119–177. - PubMed
    1. Keeley E.C., Boura J.A., Grines C.L. Comparison of Primary and Facilitated Percutaneous Coronary Interventions for ST-Elevation Myocardial Infarction: Quantitative Review of Randomised Trials. Lancet. 2006;367:579–588. doi: 10.1016/S0140-6736(06)68148-8. - DOI - PubMed
    1. Park D.W., Clare R.M., Schulte P.J., Pieper K.S., Shaw L.K., Califf R.M., Ohman E.M., van de Werf F., Hirji S., Harrington R.A., et al. Extent, Location, and Clinical Significance of Non-Infarct-Related Coronary Artery Disease among Patients with ST-Elevation Myocardial Infarction. JAMA. 2014;312:2019–2027. doi: 10.1001/jama.2014.15095. - DOI - PubMed

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