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Complete Versus Culprit-Only Revascularization in STEMI: a Contemporary Review

  • Coronary Artery Disease (D Feldman and V Voudris, Section Editors)
  • Published:
Current Treatment Options in Cardiovascular Medicine Aims and scope Submit manuscript

Abstract

Purpose of review

In ST-segment elevation myocardial infarction, urgent revascularization of the culprit coronary vessel and restoration of coronary flow is the goal of the initial management. However, obstructive non-culprit disease is frequently concomitantly found during initial angiography and portends a poor prognosis. Management of non-culprit lesions in ST-segment elevation myocardial infarction (STEMI) has been the subject of extensive debate. This review will examine the currently available evidence, with a specific focus on randomized clinical trials performed to date.

Recent findings

Although early observational data suggested better outcomes with culprit-only revascularization, more recent data from several randomized trials have suggested improved outcomes with complete multivessel revascularization, either during the index PCI procedure or as a staged procedure.

Summary

Data from recent randomized controlled trials have suggested the superiority of complete or multivessel revascularization and have subsequently led to changes to the most recent iterations of STEMI guidelines. However, the optimal management and timing of revascularization of non-culprit lesions in STEMI remain controversial.

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References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: • Of importance

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  1. Greenberg Division of Cardiology, Department of Medicine, From Weill Cornell Medical College, New York Presbyterian Hospital, 520 East 70th street, New York, NY, 10021, USA

    Daniel Y. Lu MD MHS, Ming Zhong MD & Dmitriy N. Feldman MD

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Daniel Y. Lu and Ming Zhong each declare no potential conflicts of interest.

Dmitriy N. Feldman is a section editor for Current Treatment Options in Cardiovascular Medicine.

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This article is part of the Topical Collection on Coronary Artery Disease

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Lu, D.Y., Zhong, M. & Feldman, D.N. Complete Versus Culprit-Only Revascularization in STEMI: a Contemporary Review. Curr Treat Options Cardio Med 20, 41 (2018). https://doi.org/10.1007/s11936-018-0636-9

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