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, Atherosclerotic Disease (CAD/PAD), 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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