Document Detail

Multivessel PCI in STEMI: ready to be the recommended strategy?
MedLine Citation:
PMID:  25256534     Owner:  NLM     Status:  Publisher    
Multivessel obstructive coronary artery disease is observed in about half of the STEMI patients undergoing primary PCI. Optimal management of non-culprit lesions in these settings continues to be a matter of debate and no consensus has been reached. Lack of robust scientific data led to significant heterogeneity in practice among different centres and countries. In general, three approaches have been defined in haemodynamically stable patients: an aggressive approach with non-culprit PCI during the index procedure, an intermediate approach with non-culprit PCI or CABG as a staged procedure during the index hospital stay or within 30 days, and a conservative approach with non-culprit PCI/CABG only in case of refractory symptoms or objective detection of ischaemia. Based on available data and subsequent post hoc pooled analysis, an intermediate approach has been considered as an accepted option and often adopted. Conversely, the recent PRAMI study results (Preventive Angioplasty in Acute Myocardial Infarction) suggested that an aggressive approach (including non-culprit PCI during the index procedure) provided better clinical outcome than the conservative "culprit only" approach. It is, however, as yet unknown if the aggressive approach used in the PRAMI study is also better than the traditionally advocated intermediate approach with angiographically or FFR-driven staged non-culprit revascularisation. The purpose of this review is to discuss the available evidence and integrate it into daily clinical decision making.
Thomas Cuisset; Marko Noc
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Publication Detail:
Journal Detail:
Title:  EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology     Volume:  10     ISSN:  1969-6213     ISO Abbreviation:  EuroIntervention     Publication Date:  2014 Aug 
Date Detail:
Created Date:  2014-9-26     Completed Date:  -     Revised Date:  2014-9-27    
Medline Journal Info:
Nlm Unique ID:  101251040     Medline TA:  EuroIntervention     Country:  -    
Other Details:
Languages:  ENG     Pagination:  T47-T54     Citation Subset:  -    
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