Management of non-culprit coronary plaques in patients with acute coronary syndrome.

European Heart Journal
Rocco A MontoneIk-Kyung Jang

Abstract

Approximately 50% of patients with ST-segment elevation myocardial infarction (STEMI) have multivessel coronary artery disease, a condition associated with an increased incidence of recurrent ischaemic events and higher mortality. Based on recent evidences, a strategy of staged percutaneous coronary intervention (PCI) of obstructive non-culprit lesions should be considered the gold standard for the management of these patients. However, several issues remain still unresolved. Indeed, what is the optimal timing of staged PCI is not completely defined. Moreover, assessment of intermediate non-culprit lesions represent still a clinical conundrum, as pressure-wire indexes do not seem able to correctly identify those patients in whom deferral is safe. Intracoronary imaging may help to identify untreated non-culprit lesions containing vulnerable plaques that may portend a higher risk of future cardiovascular events. However, there are hitherto no studies demonstrating that preventive PCI of vulnerable plaques or more intensive pharmacological treatment is associated with an improved clinical outcome. In this review, we discuss the recent evolving concepts about management of non-culprit plaques in STEMI patients, proposing a diagnost...Continue Reading

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Feb 3, 2021·International Journal of Cardiology·Giampaolo NiccoliUNKNOWN Interventional Cardiology and the Coronary Pathophysiology and Microcirculation Study Groups of the Italian Society of Cardi
Aug 17, 2021·Future Cardiology·Marco G Del BuonoGiampaolo Niccoli

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