Discussion
multi-vessel disease, ischemia, stenosis
ISCHEMIA, STENOSIS
In this international, randomized trial, we found that patients who underwent ischemia-guided PCI of non-culprit vessels had low ischemia burden on follow-up imaging, which was similar to that in those who underwent routine non-culprit PCI. The absolute difference in the percentage of ischemic myocardium was small, and the ischemia-guided strategy was non-inferior to routine non-culprit PCI at the pre-specified margin. These results are based on standardized image processing and interpretation at a central core lab, which was blinded to treatment allocation.The management of significantly stenosed non-culprit vessels in patients presenting with STEMI and multi-vessel disease, has evolved rapidly. Meta-analyses of recent randomized trials suggest that there is a reduction in the risk of re-infarction and repeat revascularization among patients undergoing routine PCI for non-culprit vessels.In addition, a strategy of treating all non-culprit vessels without regard to the presence of ischemia may result in a number of patients undergoing unnecessary revascularization procedures (Figure Not all angiographically stenosed non-culprit vessels need treatment. Baseline and follow-up stress MPI of a 44 year-old male smoker who presented with anterior wall STEMI and underwent primary PCI to the LAD. He had 90% stenosis of both the LCx and the RCA. (We used vasodilator stress MPI for ischemia guidance in this trial based on several considerations. First, data from previous studies have shown that it is feasible, and safe to perform vasodilator stress testing within 10 days after STEMI.