Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2023, 167(1):16-23 | DOI: 10.5507/bp.2022.024

Complete revascularization of multivessel coronary artery disease in patients with ST elevation acute coronary syndrome - for whom and when? A comprehensive review

Miloslav Spacek, Jan Vacha, Jan Precek, Martin Hutyra, Radomir Nykl, Martin Sluka, Milos Taborsky
Department of Internal Medicine I - Cardiology, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Olomouc, Czech Republic

Atherosclerosis is the most common cause of coronary steno-occlusive disease and acute myocardial infarction is the leading cause of death in industrialized countries. In patients with acute ST elevation myocardial infarction (STEMI), there is unquestionable evidence that primary percutaneous coronary intervention providing recanalization of the infarct related artery (IRA) is the preferred reperfusion strategy. Nevertheless, up to 50% of patients with STEMI have multivessel coronary artery disease defined as at least 50% stenosis exclusive of IRA. There is conflicting data regarding the optimal treatment strategy and timing in such patients. Currently, it is assumed that stable patients might benefit from complete revascularization particularly in reducing the need for future unplanned procedures but only culprit lesion should be treated during index procedure in unstable patients. In this article, we provide a comprehensive overview of this important and currently highly debated topic.

Keywords: atherosclerosis, acute ST elevation myocardial infarction (STEMI), multivessel coronary artery disease (CAD), infarct related artery (IRA), complete revascularization, coronary flow, fractional flow reserve (FFR)

Received: March 25, 2022; Revised: May 8, 2022; Accepted: May 17, 2022; Prepublished online: June 14, 2022; Published: March 15, 2023  Show citation

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Spacek, M., Vacha, J., Precek, J., Hutyra, M., Nykl, R., Sluka, M., & Taborsky, M. (2023). Complete revascularization of multivessel coronary artery disease in patients with ST elevation acute coronary syndrome - for whom and when? A comprehensive review. Biomedical papers, 167(1), 16-23. doi: 10.5507/bp.2022.024
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    References

    1. Lloyd-Jones D, Adams RJ, Brown TM, Carnethon M, Dai S, De Simone G, Ferguson TB, Ford E, Furie K, Gillespie C, Go A, Greenlund K, Haase N, Hailpern S, Ho PM, Howard V, Kissela B, Kittner S, Lackland D, Lisabeth L, Marelli A, McDermott MM, Meigs J, Mozaffarian D, Mussolino M, Nichol G, Roger VL, Rosamond W, Sacco R, Sorlie P, Stafford R, Thom T, Wasserthiel-Smoller S, Wong ND, Wylie-Rosett J; American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Executive summary: heart disease and stroke statistics-2010 update: a report from the American Heart Association. Circulation 2010;121(7):948-54. Go to original source... Go to PubMed...
    2. Falk E, Shah PK, Fuster V. Coronary plaque disruption. Circulation 1995;92(6):657-71. Go to original source... Go to PubMed...
    3. Sorajja P, Gersh BJ, Cox DA, McLaughlin MG, Zimetbaum P, Costantini C, Stuckey T, Tcheng JE, Mehran R, Lansky AJ, Grines CL, Stone GW. Impact of multivessel disease on reperfusion success and clinical outcomes in patients undergoing primary percutaneous coronary intervention for acute myocardial infarction. Eur Heart J 2007;28(14):1709-16. Go to original source... Go to PubMed...
    4. Dziewierz A, Siudak Z, Rakowski T, Zasada W, Dubiel JS, Dudek D. Impact of multivessel coronary artery disease and noninfarct-related artery revascularization on outcome of patients with ST-elevation myocardial infarction transferred for primary percutaneous coronary intervention (from the EUROTRANSFER Registry). Am J Cardiol 2010;106(3):342-7. Go to original source... Go to PubMed...
    5. Humphries SE. Guidelines for the identification and management of patients with familial hypercholesterolemia (FH): are we coming to a consensus? Atheroscler Suppl 2011;12(2):217-20. Go to original source... Go to PubMed...
    6. Vergallo R, Ren X, Yonetsu T, Kato K, Uemura S, Yu B, Jia H, Abtahian F, Aguirre AD, Tian J, Hu S, Soeda T, Lee H, McNulty I, Park SJ, Jang Y, Prasad A, Lee S, Zhang S, Porto I, Biasucci LM, Crea F, Jang IK. Pancoronary plaque vulnerability in patients with acute coronary syndrome and ruptured culprit plaque: A 3-vessel optical coherence tomography study. Am Heart J 2014;167(1):59-67. Go to original source... Go to PubMed...
    7. Coronary artery surgery study (CASS): a randomized trial of coronary artery bypass surgery. Survival data. Circulation 1983;68(5):939-50.
    8. Tonino PA, De Bruyne B, Pijls NH, Siebert U, Ikeno F, van't Veer M, Klauss V, Manoharan G, Engstrom T, Oldroyd KG, Var Lee PN, MacCarthy PA, Fearon WF; FAME Study Investigators. Fractional flow reserve versus angiography for guiding percutaneous coronary intervention. N Engl J Med 2009;360(3):213-24. Go to original source... Go to PubMed...
    9. Knuuti J, Wijns W, Saraste A, Capodanno D, Barbato E, Funck-Brentano C, Prescott E, Storey RF, Deaton C, Cuisset T, Agewall S, Dickstein K, Edvardsen T, Escaned J, Gersh BJ, Svitil P, Gilard M, Hasdai D, Hatala R, Mahfoud F, Masip J, Muneretto C, Valgimigli M, Achenbach S, Bax JJ; ESC Scientific Document Group. 2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes. Eur Heart J 2020;41(3):407-77. Go to original source... Go to PubMed...
    10. Saba L, Agarwal N, Cau R, Gerosa C, Sanfilippo R, Porcu M, Montisci R, Cerrone G, Qi Y, Balestrieri A, Lucatelli P, Politi C, Faa G, Suri JS. Review of imaging biomarkers for the vulnerable carotid plaque. JVS Vasc Sci 2021;2:149-58. doi: 10.1016/j.jvssci.2021.03.001 Go to original source... Go to PubMed...
    11. Kato K, Yonetsu K, Kim SJ, Xing L, Lee H, McNulty I, Yeh RW, Sakhuja R, Zhang S, Uemura S, Yu B, Mizuno K, Jang IK. Comparison of nonculprit coronary plaque characteristics between patients with and without diabetes: a 3-vessel optical coherence tomography study. JACC Cardiovasc Interv 2012;5(11):1150-8. Go to original source... Go to PubMed...
    12. Pundziute G, Schuijf JD, Jukema JW, Decramer I, Sarno G, Vanhoenacker PK, Boersma E, Reiber JHC, Schalij MJ, Wijns W, Bax JJ. Evaluation of plaque characteristics in acute coronary syndromes: non-invasive assessment with multi-slice computed tomography and invasive evaluation with intravascular ultrasound radiofrequency data analysis. Eur Heart J 2008;29(19):2373-81. Go to original source... Go to PubMed...
    13. Rodriguez-Granillo GA, McFadden EP, Valgimigli M, van Miegmem CAG, Regar E, de Feyter PJ, Serruys PW. Coronary plaque composition of nonculprit lesions, assessed by in vivo intracoronary ultrasound radio frequency data analysis, is related to clinical presentation. Am Heart J 2006;151(5):1020-4. Go to original source... Go to PubMed...
    14. Visseren FLJ, Mach F, Smulders YM, Carballo D, Koskinas KC, Bäck M, Benetos A, Biffi A, Boavida JM, Capodanno D, Cosyns B, Crawford C, Davos CH, Desormais I, Di Angelantonio E, Franco OH, Halvorsen S, Hobbs FDR, Hollander M, Jankowska EA, Michal M, Sacco S, Sattar N, Tokgozoglu L, Tonstad S, Tsioufis KP, van Dis I, van Gelder IC, Wanner C, Williams B; ESC National Cardiac Societies; ESC Scientific Document Group. 2021 ESC Guidelines on cardiovascular disease prevention in clinical practice. Eur Heart J 2021;42(34):3227-37. Go to original source... Go to PubMed...
    15. Hattori K, Ozaki Y, Ismail TF, Okumura M, Naruse H, Kan S, Ishikawa M, Kawai T, Ohta M, Kawai H, Hashimoto T, Takagi Y, Ishii J, Serruys PW, Narula J. Impact of statin therapy on plaque characteristics as assessed by serial OCT, greyscale and integrated backscatter-IVUS. JACC Cardiovasc Imaging 2012;5(2):169-77. Go to original source... Go to PubMed...
    16. Tahata N, Kai H, Ishibashi M, Nakaur H, Kaida H, Baba K, Hayabuchi N, Imaizumi T. Simvastatin attenuates plaque inflammation. Evaluation by fluorodeoxyglucose positron emission tomography. J Am Coll Cardiol 2006;48(9):1825-31. Go to original source... Go to PubMed...
    17. Fujimoto S, Hartung D, Ohshima S, Edwards DS, Zhou J, Yalamanchili P, Azure M, Fujimoto A, Isobe S, Matsumoto Y, Boersma H, Wong N, Yamazaki J, Narula N, Petrov A, Narula J. Molecular imaging of matrix metalloproteinase in atherosclerotic lesions. Resolution with dietary modification and statin therapy. J Am Coll Cardiol 2008;52(23):1847-57. Go to original source... Go to PubMed...
    18. Rigattieri S, Biondi-Zoccai G, Silvestri P, Di Russo C, Musto C, Ferraiuolo G, Loschiavo P. Management of multivessel coronary disease after ST elevation myocardial infarction treated by primary angioplasty. J Interv Cardiol 2008;21(1):1-7. Go to original source... Go to PubMed...
    19. Hannan EL, Samadashvili Z, Walford G, Homles DR Jr, Jacobs AK, Stamato NJ, Venditti FJ, Sharma S, King SB 3rd. Culprit vessel percutaneous coronary intervention versus multivessel and staged percutaneous coronary intervention for ST-segment elevation myocardial infarction patients with multivessel disease. JACC Cardiovasc Interv 2010;3(1):22-31. Go to original source... Go to PubMed...
    20. Toma M, Buller CE, Westerhout CM, Fu Y, O'Neill WW, Holmes DR Jr, Hamm CW, Granger CB, Armstrong PW, APEX-AMI Investigators. Non-culprit coronary artery percutaneous coronary intervention during acute ST-segment elevation myocardial infarction: insights from the APEX-AMI trial. Eur Heart J 2010;31(14):1701-7. Go to original source... Go to PubMed...
    21. Windecker S, Kolh P, Alfonso F, Collet JP, Cremer J, Falk V, Filippatos G, Hamm C, Head SJ, Jüni P, Kappetein AP, Kastrati A, Knuuti J, Landmesser U, Laufer G, Neumann FJ, Richter DJ, Schauerte P, Sousa Uva M, Stefanini GG, Taggart DP, Torracca L, Valgimigli M, Wijns W, Witkowski A. 2014 ESC/EACTS Guidelines on myocardial revascularization: The Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS) Developed with the special contribution of the European Association of Percutaneous Cardiovascular Interventions (EAPCI). Eur Heart J 2014;35(37):2541-619. Go to original source... Go to PubMed...
    22. Di Mario C, Mara S, Flavio A, Imad S, Antonio M, Anna P, Emanuela P, Stefano DS, Angelo R, Stefania C, Anna F, Carmelo C, Antonio C, Monzini N, Bonardi MA. Single vs multivessel treatment during primary angioplasty: results of the multicentre randomised HEpacoat for cuLPrit or multivessel stenting for Acute Myocardial Infarction (HELP AMI) Study. Int J Cardiovasc Intervent 2004;6(3-4):128-33. Go to original source... Go to PubMed...
    23. Politi L, Sgura F, Rossi R, Monopoli D, Guerri E, Leuzzi C, Bursi F, Sangiori GM, Modena MG. A randomised trial of target-vessel versus multi-vessel revascularisation in ST-elevation myocardial infarction: major adverse cardiac events during long-term follow-up. Heart 2010;96(9):662-7. Go to original source... Go to PubMed...
    24. Ibanez B, James S, Agewall S, Antunes MJ, Bucciarelli-Ducci C, Bueno H, Caforio ALP, Crea F, Goudevenos JA, Halvorsen S, Hindricks G, Kastrati A, Lenzen MJ, Prescott E, Roffi M, Valgimigli M, Varenhorst C, Vranckx P, Widimsky P; ESC Scientific Document Group. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J 2018;39(2):119-77. Go to original source... Go to PubMed...
    25. Wald DS, Morris JK, Wald NJ, Chase AJ, Edwards RJ, Hughes LO, Berry C, Oldroyd KG, PRAMI Investigators. Randomized trial of preventive angioplasty in myocardial infarction. N Engl J Med 2013;369(12):1115-23. Go to original source... Go to PubMed...
    26. Gershlick AH, Khan JN, Kelly DJ, Greenwood JP, Sasikaran T, Curzen N, Blackman DJ, Dalby M, Fairbrother KL, Banya W, Wang D, Flather M, Hetherington SL, Kelion AD, Talwar S, Gunning M, Hall R, Swanton H, McCann GP. Randomized trial of complete versus lesion-only revascularization in patients undergoing primary percutaneous coronary intervention for STEMI and multivessel disease: the CvLPRIT trial. J Am Coll Cardiol 2015;65(10):963-72. Go to original source... Go to PubMed...
    27. Engstrom T, Kelbaek H, Helqvist S, Hofsten DE, Klovgaard L, Holmvang L, Jorgensen E, Pedersen F, Saunamaki K, Clemmensen P, De Backer O, Ravkilde J, Tilsted HH, Villadsen AB, Aaroe J, Jensen SE, Raungaard B, Kober L; DANAMI-3-PRIMULTI Investigators. Complete revascularisation versus treatment of the culprit lesion only in patients with ST-segment elevation myocardial infarction and multivessel disease (DANAMI-3-PRIMULTI): an open-label, randomised controlled trial. Lancet 2015;386(9994):665-71. Go to original source... Go to PubMed...
    28. Smits PC, Abdel-Wahab M, Neumann FJ, Boxma-de Klerk BM, Lunde K, Schotborgh CE, Piroth Z, Horak D, Wlodarczak A, Ong PJ, Hambrecht R, Angeras O, Richardt G, Omerovic E; Compare-Acute Investigators. Fractional Flow Reserve-Guided Multivessel Angioplasty in Myocardial Infarction. N Engl J Med 2017;376(13):1234-44. Go to original source... Go to PubMed...
    29. Mehta SR, Wood DA, Storey RF, Mehran R, Bainey KR, Nguyen H, Meeks B, Di Pasquale G, Lopez-Sendon J, Faxon DP, Mauri L, Rao SV, Feldman L, Steg PG, Avezum A, Sheth T, Pinilla-Echeverri N, Moreno R, Campo G, Wrigley B, Kedev S, Sutton A, Oliver R, Rodes-Cabau J, Stankovic G, Welsh R, Lavi S, Cantor WJ, Wang J, Nakamya J, Bangdiwala SI, Cairns JA; COMPLETE Trial Steering Committee and Investigators. Complete Revascularization with Multivessel PCI for Myocardial Infarction. N Engl J Med 2019;381(15):1411-21. Go to original source... Go to PubMed...
    30. Kober L, Engstrom T. A more COMPLETE Picture of Revascularization in STEMI. N Engl J Med 2019;381(15):1472-4. Go to original source... Go to PubMed...
    31. Webb JG, Lowe AM, Sanborn TA, White HD, Sleeper LA, Carere RG, Buller CE, Wong SC, Boland J, Dzavik V, Porway M, Pate G, Bergman G, Hochman JS; SHOCK Investigators. Percutaneous coronary intervetion for cardiogenic shock in the SHOCK trial. J Am Coll Cardiol 2003;42(8):1380-6. Go to original source... Go to PubMed...
    32. Thiele H, Akin I, Sandri M, Fuernau G, de Waha S, Meyer-Saraei R, Nordbeck P, Geisler T, Landmesser U, Skurk C, Fach A, Lapp H, Piek JJ, Noc M, Goslar T, Felix SB, Maier LS, Stepinska J, Oldroyd K, Serpytis P, Montalescot G, Barthelemy O, Huber K, Windecker S, Savonitto S, Torremante P, Vrints C, Schneider S, Desch S, Zeymer U; CULPRIT-SHOCK Investigators. PCI Strategies in Patients with Acute Myocardial Infarction and Cardiogenic Shock. Engl J Med 2017;377(25):2419-32. Go to original source... Go to PubMed...
    33. Puymirat E, Cayla G, Simon T, Steg PG, Montalescot G, Durand-Zaleski I, le Bras A, Gallet R, Khalife K, Morelle J-F, Motreff P, Lemesle G, Dillinger J-G, Lhermusier T, Silvain J, Roule V, Labeque J-N, Rangé G, Ducrocq G, Cottin Y, Blanchard D, Nelson AC, De Bruyne B, Chatellier G, Danchin N, FLOWER-MI Study Investigators. Multivessel PCI Guided by FFR or Angiography for Myocardial Infarction. N Engl J Med 2021;385(4):297-308. Go to original source... Go to PubMed...

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