Treating patients with nonSTEMI Stent the culpri

Authors: Mehdi H Shishehbor Deepak L Bhatt

Publish Date: 2008/01/30

Volume: 10, Issue: 1, Pages: 93-97

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Abstract

NonST segment elevation myocardial infarction nonSTEMI is a common presentation of the acute coronary syndrome ACS spectrum Currently the recommended treatment option is an invasive approach with angiography plus coronary revascularization to treat the culprit lesion However unlike in STEMI—in which the culprit lesion can be easily identified—in nonSTEMI identifying the culprit lesion is difficult Therefore some have advocated for a more definitive approach to addressing all severe lesions in patients presenting with nonSTEMI The current European guidelines for percutaneous coronary intervention PCI for multivessel versus culpritonly stenting state that “the decision to perform either culprit vessel or complete revascularization can be made on an individual basis” whereas the American College of Cardiology/American Heart Association guidelines for multivessel PCl in patients presenting with ACS recommend that “it be performed when there is a high likelihood of success and a low risk of morbidity and the vessels to be dilated subtend a moderate or large area of viable myocardium and have high risk by noninvasive testing” Although lesions and coronary anatomies are each unique and the risk and benefit of coronary intervention to each lesion should be carefully examined we recommend stenting the culprit lesion and other severe lesions after careful consideration in a staged fashion if necessary If the severity of nonculprit lesions is in question fractional flow reserve or intravascular ultrasound should be considered

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