PCI Strategies for STEMI and Multivessel CAD
- Bates ER, Tamis-Holland JE, Bittl JA, O’Gara PT, Levine GN.
- PCI Strategies in Patients With ST-Segment Elevation Myocardial Infarction and Multivessel Coronary Artery Disease. J Am Coll Cardiol 2016;68:1066-1081.
The following are key points to remember about this review on percutaneous coronary intervention (PCI) strategies in patients with ST-segment elevation myocardial infarction (STEMI) and multivessel (MV) coronary artery disease (CAD):
- Approximately 50% of patients with STEMI have MV CAD.
- There are several potential advantages to performing MV primary PCI.
- First, acute optimization of myocardial blood supply may increase myocardial salvage in hibernating myocardium or watershed areas of infarction, improving left ventricular ejection fraction, although there are conflicting reports on benefit.
- Second, MV primary PCI may decrease the compounded risk of vascular complications from the repeat vascular punctures required in a staged procedure.
- Third, MV primary PCI may decrease hospital length of stay and use fewer resources, increasing cost-effectiveness.
- Finally, complete revascularization may decrease the risk of a future acute coronary syndrome or revascularization procedure and improve prognosis.
- There are also several potential disadvantages to performing MV primary PCI.
- First, procedure times are prolonged and there is increased radiation exposure.
- Second, higher contrast media volume increases the risk for contrast nephropathy and acute volume overload, potentially increasing hospital morbidity and mortality.
- Third, noninfarct artery stenosis severity may be acutely exaggerated as a result of circulating catecholamine-mediated vasoconstriction, and result in PCI of functionally insignificant stenoses.
- Fourth, the risk of jeopardizing remote viable myocardium during PCI of noninfarct artery stenoses (distal embolization, no-reflow, side branch occlusion, loss of collateral circulation) could result in hemodynamic instability.
- Finally, there may be increased risk for acute and subacute stent thrombosis in a prothrombotic and proinflammatory state.
Clinical Topics: Acute Coronary Syndromes, Cardiac Surgery, Heart Failure and Cardiomyopathies, Invasive Cardiovascular Angiography and Intervention, Prevention, Aortic Surgery, Cardiac Surgery and Arrhythmias, Cardiac Surgery and Heart Failure, Interventions and ACS, Interventions and Coronary Artery Disease
Keywords: Acute Coronary Syndrome, Coronary Artery Disease, Catecholamines, Constriction, Pathologic, Coronary Artery Bypass, Myocardial Infarction, Myocardial Ischemia, Myocardium, Percutaneous Coronary Intervention, Primary Prevention, Radiation, Risk Assessment, Stents, Stroke Volume, Thrombosis, Vasoconstriction
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