How Should We Manage Nonculprit Lesions in Patients with STEMI?

Complete revascularization is the clear winner.

For patients with ST-segment elevation myocardial infarction (STEMI), prompt primary percutaneous coronary intervention (PCI) of the culprit lesion is the preferred reperfusion strategy. Approximately half of all patients with STEMI have multivessel coronary artery disease (CAD); for such patients, it is unclear whether additional, nonculprit lesions warrant revascularization as well.

To determine the optimal management strategy for patients with STEMI and multivessel CAD, investigators randomized 4041 patients to undergo complete revascularization or culprit-lesion-only revascularization in a partially industry-funded trial (NCT01740479). Multivessel CAD was defined as at least one nonculprit lesion with ≥70% angiographic stenosis (by visua…

Reviewing Author

David J. Cohen, MD, MSc

Disclosures

Consultant/Advisory BoardMedtronic; Edwards Lifesciences; Abbott Vascular; Boston Scientific; St. Francis Hospital

Speaker’s BureauBoston Scientific; ZOLL Medical

Grant/Research SupportEdwards Lifesciences; Abbott Vascular; Boston Scientific; Corvia Medical; National Heart, Lung, and Blood Institute; Phillips, Inc.; St. Paul’s Hospital; V-Wave, Inc; ZOLL Medical; CathWorks, ANCORA

Editorial BoardsJACC; American Heart Journal; EuroIntervention; JSCAI; Structural Heart Journal

Leadership Positions in Professional SocietiesSociety of Thoracic Surgeons/American College of Cardiology TVT Registry (Co-Chair, Risk Model Development Committee); Cardiovascular Research Foundation (Co-Director, TCT Annual Meeting; Co-Director, New York Valves Annual Meeting)