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ST-elevation Myocardial Infarction and Multivessel Coronary Artery Disease – A Critical Review of Current Practice, Evidence and Meta-analyses

Published Online: December 23rd 2020 Heart International. 2020;14(2):Online ahead of journal publication
Authors: Filippo Figini, Shao Liang Chen, Imad Sheiban
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Article Information

In recent years, practice and guidelines for patients with ST-elevation myocardial infarction (STEMI) have evolved from a ‘culprit-only approach’ to complete revascularisation; however, several issues remain, particularly regarding assessment of non-culprit lesions and timing of their revascularization. Complete revascularisation should be performed in patients presenting with STEMI; however, available studies often present contradictory results regarding the optimal timing of non-culprit lesions percutaneous coronary intervention (PCI). The aim of this review is to provide a practical approach for the assessment of patients presenting with STEMI and multivessel coronary artery disease by analysing randomized trials, meta-analyses and our clinical experience. We recommend multivessel revascularisation at the time of primary PCI for simple cases, while we suggest to defer treatment of complex lesions; the optimal timing of staged PCI should be individualised according to clinical judgement.


Acute myocardial infarction, coronary artery disease, primary PCI


**This manuscript has been accepted for publication, but may be subject to minor changes during the production process.**

Article Information:

Filippo Figini, Shao Liang Chen and Imad Sheiban have no financial or non-financial relationships or activities to declare in relation to this article.

Compliance With Ethics

This article involves a review of literature and does not report on new clinical data, or any studies with human or animal subjects performed by any of the authors

Review Process

Double-blind peer review


The named authors meet the criteria of the International Committee of Medical Journal Editors for authorship for this manuscript, take responsibility for the integrity of the work as a whole and have given final approval for the version to be published


Imad Sheiban, Ospedale Pederzoli, via Monte Baldo 24, 37019 Peschiera del Garda (VR), Italy. E: isheiban@ospedalepederzoli.it


No funding was received for the publication of this article.

Open Access

This article is freely accessible at touchCARDIO.com © Touch Medical Media 2020.



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