4.6 Review

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

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FFR- Versus Angiography-Guided Revascularization for Nonculprit Stenosis in STEMI and Multivessel Disease A Network Meta-Analysis

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Summary: For patients with acute ST-segment elevation myocardial infarction (STEMI) and multivessel disease, guided complete revascularization (CR) using angiography or fractional flow reserve (FFR) for nonculprit stenosis is associated with a lower incidence of adverse events compared to culprit-only revascularization.

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When to Achieve Complete Revascularization in Infarct-Related Cardiogenic Shock

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Summary: Acute myocardial infarction complicated by cardiogenic shock is a life-threatening condition frequently encountered in patients with multivessel coronary artery disease. Current recommendations suggest a culprit lesion-only revascularization strategy and the use of mechanical circulatory support devices as a key therapeutic option. The importance of shock teams and medical care system networks to effectively impact clinical outcomes is also highlighted.

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Multivessel Versus Culprit-Vessel Percutaneous Coronary Intervention in Patients With Non-ST-Segment Elevation Myocardial Infarction and Cardiogenic Shock

Mohamed A. Omer et al.

Summary: The study found that for patients with NSTEMI, MVD, and cardiogenic shock, multivessel PCI can reduce in-hospital mortality but comes with more peri-procedural complications. However, among patients surviving discharge, multivessel PCI does not confer additional long-term mortality benefit.

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Etienne Puymirat et al.

Summary: In patients with STEMI undergoing complete revascularization, an FFR-guided strategy did not have a significant benefit over an angiography-guided strategy with respect to the risk of death, myocardial infarction, or urgent revascularization at 1 year. However, the findings do not allow for a conclusive interpretation due to wide confidence intervals.

NEW ENGLAND JOURNAL OF MEDICINE (2021)

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Compared Outcomes of ST-Segment-Elevation Myocardial Infarction Patients With Multivessel Disease Treated With Primary Percutaneous Coronary Intervention and Preserved Fractional Flow Reserve of Nonculprit Lesions Treated Conservatively and of Those With Low Fractional Flow Reserve Managed Invasively: Insights From the FLOWER-MI Trial

Pierre Denormandie et al.

Summary: In patients with ST-segment-elevation myocardial infarction, using an FFR-guided PCI strategy for nonculprit lesions resulted in better clinical outcomes at 1 year. Deferred PCI may not be optimal in this specific context.

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Nonculprit Lesion Severity and Outcome of Revascularization in Patients With STEMI and Multivessel Coronary Disease

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2018 ESC/EACTS Guidelines on myocardial revascularization

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Complete Revascularization with Multivessel PCI for Myocardial Infarction

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Timing of Staged Nonculprit Artery Revascularization in Patients With ST-Segment Elevation Myocardial Infarction COMPLETE Trial

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Multivessel Percutaneous Coronary Intervention in Patients With ST-Segment Elevation Myocardial Infarction With Cardiogenic Shock

Joo Myung Lee et al.

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One-Year Outcomes after PCI Strategies in Cardiogenic Shock

H. Thiele et al.

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Fractional Flow Reserve-Guided Multivessel Angioplasty in Myocardial Infarction

Pieter C. Smits et al.

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Extent, Location, and Clinical Significance ? of Non-Infarct-Related Coronary Artery Disease Among Patimts With ST-Elevation Myocardial Infarction

Duk-Woo Park et al.

JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION (2014)

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Trends in Incidence, Management, and Outcomes of Cardiogenic Shock Complicating ST-Elevation Myocardial Infarction in the United States

Dhaval Kolte et al.

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Randomized Trial of Preventive Angioplasty in Myocardial Infarction

David S. Wald et al.

NEW ENGLAND JOURNAL OF MEDICINE (2013)

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Cardiogenic shock complicating acute coronary syndromes: Insights from the Global Registry of Acute Coronary Events

Hamza H. Awad et al.

AMERICAN HEART JOURNAL (2012)

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Fractional Flow Reserve for the Assessment of Nonculprit Coronary Artery Stenoses in Patients With Acute Myocardial Infarction

Argyrios Ntalianis et al.

JACC-CARDIOVASCULAR INTERVENTIONS (2010)

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Early revascularization and long-term survival in cardiogenic shock complicating acute myocardial infarction

Judith S. Hochman et al.

JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION (2006)