ST-Elevation Myocardial Infarction: Preventive Percutaneous Coronary Intervention in the Non-Culprit Vessel

Patients with ST-segment elevation myocardial infarction (STEMI) and multi-vessel disease (MVD) have poorer outcomes after primary percutaneous coronary intervention (PCI) compared to those with one-vessel coronary artery disease. Current STEMI guidelines recommend revascularization of the infarct related artery (IRA) only during primary PCI, while PCI for non-IRA lesions should be performed after objective evidence of residual ischemia. Evidence regarding the optimal management strategy for non-IRA lesions in STEMI patients with MVD has been limited and mainly based on retrospective, contradictory and probably biased data. A recently published randomized study, PRAMI, challenges the guidelines since preventive acute multi-vessel PCI for significant stenoses in non-IRAs has been associated with a reduction of major adverse cardiovascular events (MACE) compared to PCI limited to the IRA. A review of the literature and a discussion about the implications of the PRAMI study regarding the optimal revascularization strategy for STEMI with MVD are presented herein.