Culprit-Only Artery Versus Multivessel Disease

Abstract

Primary percutaneous coronary intervention (PPCI) is the treatment of choice in patients presenting with ST-segment elevation myocardial infarction (STEMI). In contemporary practice, among patients who present to the hospital with STEMI, between 40 and 65% have concurrent multi-vessel (MV) coronary artery disease (CAD), a combination of a thrombotic culprit lesion and one or more significant (50% or more diameter stenosis) non-culprit lesions in other coronary artery territories on coronary angiography. Optimal management of these non-culprit lesions in this setting is still a matter of debate. STEMI patients with MV CAD are at higher risk of recurrent cardiovascular events. However, PCI of bystander lesions during PPCI can bring potential complications. The presence of MV CAD in STEMI patients often poses therapeutic dilemma for interventional cardiologists as there are multiple possible strategies and controversial data. Besides clinical relevance, as the burden of cardiovascular disease affects hospital systems around the world, there is growing interest to examine and improve the various treatment strategies involved in the management of STEMI with MV CAD.