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STEMI — EECC MCQ

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ModerateCoronary Artery DiseaseSTEMIEECC

A 68-year-old man with hypertension and type 2 diabetes mellitus underwent primary PCI with a drug-eluting stent to the proximal left anterior descending artery for an anterior STEMI 3 days ago. At angiography, a 70% stenosis was also noted in the mid-right coronary artery. He is now pain-free and haemodynamically stable. His echocardiogram shows an LVEF of 45% with anterior wall hypokinesis. What is the recommended approach to the non-culprit right coronary artery lesion?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: D — Complete revascularisation of the non-culprit lesion either during the index procedure or within 45 days

Explanation lettering: D = shown as B · B = shown as D

The 2023 ESC ACS Guidelines recommend complete revascularisation in patients with STEMI and multivessel disease, either during the index PCI or within 45 days (Class I, LOE A), based on COMPLETE, FIRE, and other trials. Medical therapy alone (A) is inferior. Non-invasive testing (C) is not required before proceeding with revascularisation of angiographically significant non-culprit lesions in the STEMI context. CTCA (D) adds no value when the lesion has already been characterised invasively. Waiting for symptoms (E) is not recommended.

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