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Complete Revascularisation in STEMI — EECC MCQ

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ModerateCoronary Artery DiseaseComplete Revascularisation in STEMIEECC

A 67-year-old man presents with an anterior STEMI. Primary PCI to the culprit mid-LAD is successful. Angiography also reveals a 90% stenosis in the proximal RCA and a 70% stenosis in the OM1. According to the 2023 ESC ACS Guidelines, what is the recommended approach to the non-culprit lesions?

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Correct answer: E — Complete revascularisation of haemodynamically significant non-culprit lesions either during the index procedure or as a staged procedure before discharge

The 2023 ESC ACS Guidelines recommend complete revascularisation of non-culprit lesions in STEMI patients with multivessel disease (Class I, LOE A), based on the COMPLETE, PRAMI, CvLPRIT, and DANAMI-3-PRIMULTI trials. This can be performed either during the index procedure or as a staged procedure (preferably before hospital discharge or within 45 days). FFR/iFR-guided assessment of non-culprit lesions is reasonable but not mandatory. The timing (immediate vs staged) should be guided by clinical stability, lesion complexity, contrast load, and operator judgement. Staged PCI is generally preferred for complex non-culprit lesions.

Reference: ESC (2023): Guidelines for the Management of Acute Coronary Syndromes