Complete revascularisation should be immediate in STEMI: pros and cons

Multivessel coronary artery disease often occurs in patients presenting with ST-segment elevation myocardial infarction (STEMI). Current European guidelines on acute coronary syndromes (ACS) recommend complete revascularisation in such patients, but there is no consensus on the optimal timing. As such, percutaneous coronary intervention (PCI) of the non-infarct-related arteries (IRAs) can be performed either immediately (i.e., during the primary PCI) or in a staged (i.e., within 45 days) procedure. Although an immediate complete revascularisation can reduce the use of contrast medium and radiation and can be more practical in off-hours procedures, there are factors that favour a staged approach, including the high thrombo-inflammatory burden, an impaired evaluation of non-IRAs and the lack of information about patient history and comorbidities. Both these strategies have pros and cons, and the optimal timing for complete revascularisation remains a subject of debate.

Pros

Primary PCI with treatment of the culprit lesion is the standard of care for patients with STEMI1. Existing evidence supports the benefits of complete revascularisation (CR) over culprit lesion-only PCI in STEMI with multiple...