Timing and modality of complete revascularization in patients presenting with ST-segment elevation myocardial infarction and multivessel coronary artery disease

Approximately half of the patients presenting with ST-segment elevation myocardial infarction have also sig-nificant atherosclerotic disease affecting coronary segments other than the infarct-related artery. Optimal management of residual lesions in this clinical setting has been a topic of intense research in the last decade. On the one hand, a large body of evidence has consistently shown the benefit of complete revascularization for the reduction of adverse cardiovascular outcomes. On the other hand, some crucial aspects such as the optimal timing or the best strategy of the complete treatment approach remain a matter of controversy. In this review, we aim to provide a thorough critical appraisal of the available literature regarding this topic, by discussing areas of relative certainty, gaps in the knowledge, approach to specific clinical subsets and future research directions.

Automated summary

Approximately half of the patients with ST-segment elevation myocardial infarction have additional atherosclerotic lesions in coronary segments other than the infarct-related artery. The optimal management of these residual lesions has been extensively studied, with evidence supporting the benefits of complete revascularization. However, controversies exist regarding the timing and strategy of treatment. This review provides a critical appraisal of the available literature, discussing areas of certainty, knowledge gaps, approaches for specific clinical subsets, and future research directions.