Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2023 Jul 7;12(13):4550.
doi: 10.3390/jcm12134550.

Moving toward Precision Medicine in Acute Coronary Syndromes: A Multimodal Assessment of Non-Culprit Lesions

Michele Bellino  1 , Angelo Silverio  1 , Luca Esposito  1 , Francesco Paolo Cancro  1 , Germano Junior Ferruzzi  1 , Marco Di Maio  1 , Antonella Rispoli  1 , Maria Giovanna Vassallo  1 , Francesca Maria Di Muro  2 , Gennaro Galasso  1 , Giuseppe De Luca  3   4
Affiliations
Review

Moving toward Precision Medicine in Acute Coronary Syndromes: A Multimodal Assessment of Non-Culprit Lesions

Michele Bellino et al. J Clin Med. .

Abstract

Patients with acute coronary syndrome and multivessel disease experience several recurrent adverse events that lead to poor outcomes. Given the complexity of treating these patients, and the extremely high risk of long-term adverse events, the assessment of non-culprit lesions becomes crucial. Recently, two trials have shown a possible clinical benefit into treat non-culprit lesions using a fraction flow reserve (FFR)-guided approach, compared to culprit-lesion-only PCI. However, the most recent FLOW Evaluation to Guide Revascularization in Multivessel ST-elevation Myocardial Infarction (FLOWER-MI) trial did not show a benefit of the use of FFR-guided PCI compared to an angiography-guided approach. Otherwise, intracoronary imaging using optical coherence tomography (OCT), intravascular ultrasound (IVUS), or near-infrared spectroscopy (NIRS) could provide both quantitative and qualitative assessments of non-culprit lesions. Different studies have shown how the characterization of coronary lesions with intracoronary imaging could lead to clinical benefits in these peculiar group of patients. Moreover, non-invasive evaluations of NCLs have begun to take ground in this context, but more insights through adequately powered and designed studies are needed. The aim of this review is to outline the available techniques, both invasive and non-invasive, for the assessment of multivessel disease in patients with STEMI, and to provide a systematic guidance on the assessment and approach to these patients.

Keywords: IVUS; OCT; acute coronary syndrome; cardiac magnetic resonance; coronary computed tomography angiography; intracoronary imaging; multivessel disease; non-culprit lesion.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Focuses on the management provided by the main studies regarding management of multi-vessel disease in ACS.
Figure 2
Figure 2
Panel (A,B); OCT images showing non-culprit lesion with plaque vulnerability characteristics: thin cap fibroatheroma, macrophage present in the fibrous cap, and high lipid core burden (white arrows).
Figure 3
Figure 3
Panel (A,B); OCT images showing non-culprit lesion with necrotic lipid core (white arrows).
Figure 4
Figure 4
Operational algorithm for the management of multivessel disease in patients with acute coronary syndrome without cardiogenic shock. ACS, acute coronary syndrome; AKI, acute kidney injury; CABG, coronary artery bypass grafting; EF, ejection fraction; FFR, fractional flow reserve; MLA, minimal lumen area; MSA, minimal stent area; NCLs, non-culprit lesions; NIRS, near infrared spectroscopy; OCT, optical coherence tomography; OMT, optimal medical therapy; PCI, percutaneous coronary intervention; TCFA, thin cap fibro-atheroma.
See this image and copyright information in PMC

References

    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
    1. Sorajja P., Gersh B.J., Cox D.A., McLaughlin M.G., Zimetbaum P., Costantini C., Stuckey T., Tcheng J.E., Mehran R., Lansky A.J., et al. Impact of multivessel disease on reperfusion success and clinical outcomes in patients undergoing primary percutaneous coronary intervention for acute myocardial infarction. Eur. Heart J. 2007;28:1709–1716. doi: 10.1093/eurheartj/ehm184. - DOI - PubMed
    1. Parodi G., Memisha G., Valenti R., Trapani M., Migliorini A., Santoro G.M., Antoniucci D. Five year outcome after primary coronary intervention for acute ST elevation myocardial infarction: Results from a single centre experience. Heart. 2005;91:1541–1544. doi: 10.1136/hrt.2004.054692. - DOI - PMC - PubMed
    1. Galasso G., De Angelis E., Silverio A., Di Maio M., Cancro F.P., Esposito L., Bellino M., Scudiero F., Damato A., Parodi G., et al. Predictors of Recurrent Ischemic Events in Patients With ST-Segment Elevation Myocardial Infarction. Am. J. Cardiol. 2021;159:44–51. doi: 10.1016/j.amjcard.2021.08.019. - DOI - 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. doi: 10.1093/eurheartj/ehx393. - DOI - PubMed

LinkOut - more resources