How to treat patients with ST-elevation acute myocardial infarction and multi-vessel disease?

Petr Widimsky, David R. Holmes

Research output: Contribution to journalReview articlepeer-review

59 Scopus citations

Abstract

Over 50% of ST-segment elevation myocardial infarction (STEMI) patients suffer multi-vessel coronary artery disease, which is known to be associated with worse prognosis. Treatment strategies used in clinical practice vary from acute multi-vessel percutaneous coronary intervention (PCI), through staged PCI procedures to a conservative approach with primary PCI of only the infarct-related artery (IRA) and subsequent medical therapy unless recurrent ischaemia occurs. Each approach has advantages and disadvantages. This review paper summarizes the international experience and authors' opinion on this clinically important question. Multi-vessel disease in STEMI is not a single entity and thus the treatment approach should be individualized. However, the following general rules can be proposed till future large randomized trials prove otherwise: (i) Single-vessel acute PCI should be the default strategy (to treat only the IRA during the acute phase of STEMI). (ii) Acute multi-vessel PCI can be justified only in exceptional patients with multiple critical (>90%) and potentially unstable lesions. (iii) Significant lesions of the non-infarct arteries should be treated either medically or by staged revascularization procedures - both options are currently acceptable. Published on behalf of the European Society of Cardiology. All rights reserved.

Original languageEnglish (US)
Pages (from-to)396-403
Number of pages8
JournalEuropean heart journal
Volume32
Issue number4
DOIs
StatePublished - Feb 2011

Keywords

  • Acute myocardial infarction
  • Medical therapy
  • Multi-vessel angioplasty
  • Multi-vessel disease
  • Primary percutaneous coronary intervention
  • Staged angioplasty

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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