J Cardiovasc Interv.  2023 Jul;2(3):161-169. 10.54912/jci.2023.0003.

Intracoronary Imaging-Guided Revascularization for Non-Culprit Lesions in Patients With ST-Elevation Myocardial Infarction and Multivessel Disease

• Seung J
• Choo EH
• Choi IJ
• Lim S
• Moon D
• Lee KY
• Oh GC
• Hwang BH
• Choi YS
• Park HJ
• Chang K

• KMID: 2560943
• DOI: http://doi.org/10.54912/jci.2023.0003

Abstract

Complete revascularization in patients with ST-elevation myocardial infarction (STEMI) and multivessel disease is essential for reducing future cardiac events and is strongly recommended in the current guidelines. However, there is a lack of data on selecting a nonculprit lesion on which to perform percutaneous coronary intervention (PCI). Angiographyguided PCI for the non-culprit lesion is currently the most widely used method. Considering the results of studies in which fractional flow reserve (FFR)-guided PCI improved patients’ prognoses with fewer stents than angiography-guided PCI in patients with stable coronary disease, similar results are expected in patients with STEMI and multivessel disease. but studies are conflicting. Because the non-culprit lesions of STEMI have a high incidence of vulnerable plaques and are associated with a high risk of future cardiovascular events, using an intracoronary imaging device to determine plaque characteristics is thought to be helpful. A study comparing FFR-guided PCI and intracoronary imaging-guided PCI was recently published, demonstrating the usefulness of intracoronary imaging-guided PCI. Therefore, a future study to evaluate the efficacy of intracoronary imaging to determine PCI of non-culprit lesions in patients with STEMI and multivessel disease is warranted.

Keyword

Myocardial infarction; Coronary artery disease; Coronary angiography; Optical coherence tomography; Fractional flow reserve, myocardial