How to Detect and When to Treat Nonculprit Coronary Lesions in STEMI?

Clinical Takeaway

: Immediate invasive assessment of nonculprit lesions was no better than delayed stress MRI for guiding additional stenting in multivessel disease.

Context

When patients with ST-segment myocardial infarction (STEMI) have stenosis in vessels other than the index coronary vessel, guidelines recommend stenting all significant lesions, but the timing of the interventions is not well defined. Interventional cardiologists can measure — at the time of STEMI treatment — intracoronary pressures and calculate iFR (instantaneous wave-free ratio), a pressure-derived index, to assess whether a nonculprit stenosis is causing ischemia. Alternatively, stress MRI provides a noninvasive, physiologic map of ischemic myocardium, but this is delayed to after the STEMI intervention. Stress MRI helps clinicians decide which additional blockages truly need stenting without the risks or overestimation associate…

Reviewing Author

Vlad G. Zaha, M.D., Ph.D., F.A.C.C., F.A.H.A.

Disclosures

Grant/Research SupportCancer Prevention and Research Institute of Texas; National Institute of Health

Editorial BoardsCirculation

Leadership Positions in Professional SocietiesTexas Chapter of the American College of Cardiology (Section Chair, Cardio-Oncology)