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Non-Infarct Related Artery Intervention in St-Elevation Myocardial Infarc-
182 tion With Multivessel Disease: MultiVessel PCI in STEMI:
Timing of Intervention?

bypass grafting, and a 40% decrease in MACEs with multivessel revascularization compared to culprit only
revascularisation [4]. But the timing multivessel PCI is variable from during index PCI to upto 60 days after
discharge. Another mata-analysis by Vlaar PJ et al[5] have defined 3 approaches for non-culprit intervention
in MVD-STEMI patients; aggressive approach (multivessel PCI at the time of index procedure), intermediate
approach (staged PCI during index hospital stay or within 30days of index procedure) or conservative ap-
proach (non-culprit intervention only in case of refractory symptoms or objective evidence of ischaemia). This
large meta-analysis which included more than 40,000 patients have suggested that non-culprit multivessel
PCI during the index p-PCI should be discouraged, and suitable significant non-culprit lesions treated only
during the staged procedure, this being associated with lower short- and long-term mortality as compared to
index non-culprit multivessel PCI (fig. ). This meta-analysis and a substudy of HORIZON-AMI[6] showed that
aggressive approach has the worst outcome. The main disadvantage of aggressive approach is increased
radiation dose, increased contrast use, increased procedural complications, and a theoretical increase in risk
of stent thrombosis because of a prothrombotic proinflammatory state with subsequent increase in in-hospi-
tal outcomes and length of stay. Few single centre trials and observational studies had shown benefit in the
aggressive approach. So 2011 AHA guidelines for percutaneous coronary interventions and 2012 European
society of cardiology STEMI guidelines have recommended PCI in non-infarct related artery in hemodynam-
ically STEMI patient as class III (level of evidence-B) intervention and limit the non-culprit PCI during the
index p-PCI only in the setting of cardiogenic shock (class of recommendation-IIa, level of evidence-B)[7,8].

GCDC 2017