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Title: Management of Multivessel Coronary Disease in ST-segment Elevation Myocardial Infarction
Authors: Banning, Amerjeet S.
Gershlick, Anthony H.
First Published: 4-Aug-2015
Publisher: Current Medicine Group
Citation: Current Cardiology Reports, 2015, 17 (9), pp. 632-?
Abstract: Primary PCI of infarct-related arteries is the preferred reperfusion strategy in patients presenting with ST-segment elevation myocardial infarction (STEMI). Up to 40 % of such patients demonstrate evidence of multivessel, non-infarct-related artery coronary disease. Previous non-randomised observational studies and their associated meta-analyses have suggested that in such cases only the culprit infarct-related artery (IRA) lesion should be treated. However, recent randomised controlled trials have demonstrated improved clinical outcomes with lower major adverse cardiovascular events (MACE) rates when complete revascularisation is undertaken either at index primary percutaneous coronary intervention (PPCI) or during index admission. These trials suggest that current guidelines pertaining to treatment of non-infarct-related artery (N-IRA) lesions in STEMI patients with multivessel disease may need to be reconsidered depending on future trials. However, issues remain around timing of N-IRA intervention, the use of fractional flow reserve (FFR) or intravascular imaging to guide intervention in N-IRA lesions and the need to demonstrate reductions in hard clinical endpoints (death and MI) after complete revascularisation; these issues will need to be addressed through future trials. Clinicians must judge on the currently available data, whether it is still safer to leave important stenosis in N-IRA untreated.
DOI Link: 10.1007/s11886-015-0632-6
ISSN: 1523-3782
eISSN: 1534-3170
Version: Publisher Version
Status: Peer-reviewed
Type: Journal Article
Rights: The Author(s) 2015. This article is published with open access at This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://, which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
Description: This article is part of the Topical Collection on Management of Acute Coronary Syndromes
Appears in Collections:Published Articles, Dept. of Cardiovascular Sciences

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