Culprit-Only vs. Complete Revascularization During ST-Segment Elevation Myocardial Infarction.

Primary percutaneous intervention (PCI) is the treatment of choice for ST-segment elevation myocardial infarction (STEMI). Patients with STEMI frequently have obstructive non-culprit lesions. In addition, STEMI patients with multivessel disease are at increased risk of major adverse cardiac events. However, current guidelines do not recommend revascularization of non-culprit lesions unless complicated by cardiogenic shock. Prior observational and small randomized controlled trials (RCTs) have demonstrated conflicting results pertaining to the optimal revascularization strategy in STEMI patients with multivessel disease undergoing primary PCI. Recent randomized studies, PRAMI, CvLPRIT, and DANAMI-3-PRIMULTI, provide encouraging data that suggest potential benefit with complete revascularization in STEMI patients with obstructive non-culprit lesions. However, further data from large RCTs are needed to investigate the impact of this strategy on recurrent myocardial infarction/death and to determine the best timing of staged procedures for complete revascularization. Until then, a personalized approach should be taken to optimize the revascularization strategy in STEMI patients with obstructive non-culprit lesions.