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  • Review Article
  • Published:

Reperfusion strategies in acute myocardial infarction and multivessel disease

Nature Reviews Cardiology volume 14, pages 665–678 (2017)Cite this article

Subjects

Key Points

  • Approximately 50% of patients with ST-segment elevation myocardial infarction (STEMI) have multivessel disease

  • Whether patients with STEMI and multivessel disease should receive percutaneous coronary intervention (PCI) of only the culprit vessel or complete revascularization, either in a simultaneous or staged approach, remains uncertain

  • Increasing evidence from randomized controlled trials suggests that multivessel PCI is safe or even beneficial in selected patients, compared with culprit vessel-only PCI

  • Results from adequately-powered randomized controlled trials are still needed to determine the optimal reperfusion strategy in patients with STEMI and multivessel disease

Abstract

Approximately 50% of patients with ST-segment elevation myocardial infarction (STEMI) have multivessel disease. The optimal reperfusion strategy in these patients is still uncertain. Whether percutaneous coronary intervention (PCI) of only the culprit vessel or a strategy of complete revascularization, either in a simultaneous or staged multivessel PCI approach, should be performed remains unclear. Although a large number of observational studies have mostly shown worse clinical outcomes associated with a multivessel PCI approach, increasing evidence from randomized controlled trials suggests that multivessel PCI is safe, while reducing the need for revascularization in selected patients, compared with culprit vessel-only PCI. However, adequately-powered studies are still needed to determine the best treatment strategy in patients with STEMI and multivessel disease, particularly to demonstrate a reduction in the hard end point of death or myocardial infarction. In this Review, we provide a comprehensive summary of current evidence on the different treatment options for patients with STEMI and multivessel disease, highlighting current guideline recommendations and providing future directions on reperfusion strategies in these patients.

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Figure 1: PCI strategies in patients with STEMI and multivessel disease.
Figure 2: Observational studies on culprit vessel-only PCI versus multivessel primary PCI.
Figure 3: Observational studies on culprit vessel-only PCI versus staged multivessel PCI.
Figure 4: Observational studies on multiple treatment strategies.
Figure 5: Randomized controlled trials on culprit vessel-only PCI versus multivessel PCI.
Figure 6: Decision process and reperfusion options in patients with STEMI and multivessel disease.

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Authors and Affiliations

  1. Icahn School of Medicine at Mount Sinai, The Zena and Michael A. Wiener Cardiovascular Institute, One Gustave L. Levy Place, Box 1030, New York, 10029, New York, USA

    Birgit Vogel & Roxana Mehran

  2. Population Health Research Institute, McMaster University and Hamilton Health Sciences, 237 Barton Street East, Hamilton, L8L 2X2, Ontario, Canada

    Shamir R. Mehta

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  1. Birgit Vogel
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  2. Shamir R. Mehta
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  3. Roxana Mehran
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Contributions

B.V. researched data for the article and wrote the manuscript. S.R.M. and R.M. reviewed and edited the manuscript before submission.

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Correspondence to Roxana Mehran.

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The authors declare no competing financial interests.

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Vogel, B., Mehta, S. & Mehran, R. Reperfusion strategies in acute myocardial infarction and multivessel disease. Nat Rev Cardiol 14, 665–678 (2017). https://doi.org/10.1038/nrcardio.2017.88

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