{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,23]],"date-time":"2026-08-23T14:47:27Z","timestamp":1787496447504,"version":"build-2736575974"},"reference-count":33,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2024,3,26]],"date-time":"2024-03-26T00:00:00Z","timestamp":1711411200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>The proportion of patients with multivessel coronary artery disease in individuals experiencing acute coronary syndrome (ACS) varies based on age and ACS subtype. In patients with ST-segment elevation myocardial infarction (STEMI) without cardiogenic shock, the prognostic benefit of complete revascularization has been demonstrated by several randomized trials and meta-analyses, leading to a strong guideline recommendation. However, similar data are lacking for ACS without ST-segment elevation (NSTE-ACS). Non-randomized data suggesting a benefit from complete revascularization in non-ST-segment elevation myocardial infarction (NSTEMI) are prone to selection bias and should be interpreted with caution. A series of large randomized controlled trials have been initiated recently to address these open questions.<\/jats:p>","DOI":"10.3390\/jcm13071918","type":"journal-article","created":{"date-parts":[[2024,3,26]],"date-time":"2024-03-26T11:05:33Z","timestamp":1711451133000},"page":"1918","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Revascularization Strategy in Myocardial Infarction with Multivessel Disease"],"prefix":"10.3390","volume":"13","author":[{"given":"Alexander","family":"Jobs","sequence":"first","affiliation":[{"name":"Department of Internal Medicine\/Cardiology and Leipzig Heart Institute, Heart Center Leipzig at University of Leipzig, Str\u00fcmpellstr. 39, Russenstra\u00dfe 69a, 04289 Leipzig, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steffen","family":"Desch","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine\/Cardiology and Leipzig Heart Institute, Heart Center Leipzig at University of Leipzig, Str\u00fcmpellstr. 39, Russenstra\u00dfe 69a, 04289 Leipzig, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anne","family":"Freund","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine\/Cardiology and Leipzig Heart Institute, Heart Center Leipzig at University of Leipzig, Str\u00fcmpellstr. 39, Russenstra\u00dfe 69a, 04289 Leipzig, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hans-Josef","family":"Feistritzer","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine\/Cardiology and Leipzig Heart Institute, Heart Center Leipzig at University of Leipzig, Str\u00fcmpellstr. 39, Russenstra\u00dfe 69a, 04289 Leipzig, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0169-998X","authenticated-orcid":false,"given":"Holger","family":"Thiele","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine\/Cardiology and Leipzig Heart Institute, Heart Center Leipzig at University of Leipzig, Str\u00fcmpellstr. 39, Russenstra\u00dfe 69a, 04289 Leipzig, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,3,26]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"3720","DOI":"10.1093\/eurheartj\/ehad191","article-title":"2023 ESC Guidelines for the management of acute coronary syndromes","volume":"44","author":"Byrne","year":"2023","journal-title":"Eur. Heart J."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1748","DOI":"10.1016\/j.jacc.2013.05.071","article-title":"In vivo diagnosis of plaque erosion and calcified nodule in patients with acute coronary syndrome by intravascular optical coherence tomography","volume":"62","author":"Jia","year":"2013","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1377","DOI":"10.1093\/eurheartj\/ehv029","article-title":"Plaque rupture and intact fibrous cap assessed by optical coherence tomography portend different outcomes in patients with acute coronary syndrome","volume":"36","author":"Niccoli","year":"2015","journal-title":"Eur. Heart J."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"140","DOI":"10.1016\/j.ahj.2007.09.007","article-title":"Culprit-only or multivessel revascularization in patients with acute coronary syndromes: An American College of Cardiology National Cardiovascular Database Registry report","volume":"155","author":"Brener","year":"2008","journal-title":"Am. Heart J."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"2019","DOI":"10.1001\/jama.2014.15095","article-title":"Extent, location, and clinical significance of non-infarct-related coronary artery disease among patients with ST-elevation myocardial infarction","volume":"312","author":"Park","year":"2014","journal-title":"JAMA"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1989","DOI":"10.1016\/j.jacc.2018.07.089","article-title":"Complete Versus Culprit-Only Lesion Intervention in Patients with Acute Coronary Syndromes","volume":"72","author":"Rathod","year":"2018","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"2419","DOI":"10.1056\/NEJMoa1710261","article-title":"PCI Strategies in Patients with Acute Myocardial Infarction and Cardiogenic Shock","volume":"377","author":"Thiele","year":"2017","journal-title":"N. Engl. J. Med."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1411","DOI":"10.1056\/NEJMoa1907775","article-title":"Complete Revascularization with Multivessel PCI for Myocardial Infarction","volume":"381","author":"Mehta","year":"2019","journal-title":"N. Engl. J. Med."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"297","DOI":"10.1056\/NEJMoa2104650","article-title":"Multivessel PCI Guided by FFR or Angiography for Myocardial Infarction","volume":"385","author":"Puymirat","year":"2021","journal-title":"N. Engl. J. Med."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"e011314","DOI":"10.1161\/CIRCINTERVENTIONS.121.011314","article-title":"Compared Outcomes of ST-Segment-Elevation Myocardial Infarction Patients with Multivessel Disease Treated with Primary Percutaneous Coronary Intervention and Preserved Fractional Flow Reserve of Nonculprit Lesions Treated Conservatively and of Those with Low Fractional Flow Reserve Managed Invasively: Insights from the FLOWER-MI Trial","volume":"14","author":"Denormandie","year":"2021","journal-title":"Circ. Cardiovasc. Interv."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"736","DOI":"10.1001\/jamacardio.2019.2138","article-title":"Temporal Changes in Coronary Hyperemic and Resting Hemodynamic Indices in Nonculprit Vessels of Patients with ST-Segment Elevation Myocardial Infarction","volume":"4","author":"Janssens","year":"2019","journal-title":"JAMA Cardiol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"e008768","DOI":"10.1161\/CIRCINTERVENTIONS.119.008768","article-title":"Nonculprit Lesion Plaque Morphology in Patients with ST-Segment-Elevation Myocardial Infarction: Results from the COMPLETE Trial Optical Coherence Tomography Substudys","volume":"13","author":"Mehta","year":"2020","journal-title":"Circ. Cardiovasc. Interv."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"665","DOI":"10.1016\/S0140-6736(15)60648-1","article-title":"Complete revascularisation versus treatment of the culprit lesion only in patients with ST-segment elevation myocardial infarction and multivessel disease (DANAMI-3-PRIMULTI): An open-label, randomised controlled trial","volume":"386","author":"Engstrom","year":"2015","journal-title":"Lancet"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1016\/j.jcin.2019.09.034","article-title":"Fractional Flow Reserve or Optical Coherence Tomography to Guide Management of Angiographically Intermediate Coronary Stenosis: A Single-Center Trial","volume":"13","author":"Burzotta","year":"2020","journal-title":"JACC Cardiovasc. 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Interv."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1091","DOI":"10.1001\/jamacardio.2022.3032","article-title":"Complete Revascularization vs Culprit Lesion-Only Percutaneous Coronary Intervention for Angina-Related Quality of Life in Patients with ST-Segment Elevation Myocardial Infarction: Results from the COMPLETE Randomized Clinical Trial","volume":"7","author":"Mehta","year":"2022","journal-title":"JAMA Cardiol."},{"key":"ref_18","first-page":"e6","article-title":"Heart disease and stroke statistics\u20142013 update: A report from the American Heart Association","volume":"127","author":"Go","year":"2013","journal-title":"Circulation"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1908","DOI":"10.1161\/CIRCULATIONAHA.117.030798","article-title":"Acute Myocardial Infarction: Changes in Patient Characteristics, Management, and 6-Month Outcomes Over a Period of 20 Years in the FAST-MI Program (French Registry of Acute ST-Elevation or Non-ST-Elevation Myocardial Infarction) 1995 to 2015","volume":"136","author":"Puymirat","year":"2017","journal-title":"Circulation"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"614","DOI":"10.1007\/s00392-022-02145-5","article-title":"Comparison of plug-based versus suture-based vascular closure for large-bore arterial access: A collaborative meta-analysis of observational and randomized studies","volume":"112","author":"Dumpies","year":"2023","journal-title":"Clin. Res. Cardiol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1501","DOI":"10.1016\/j.amjcard.2019.07.071","article-title":"Meta-analysis Comparing Multivessel Versus Culprit Coronary Arterial Revascularization for Patients with Non-ST-Segment Elevation Acute Coronary Syndromes","volume":"124","author":"Siebert","year":"2019","journal-title":"Am. J. Cardiol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"889","DOI":"10.1056\/NEJMoa2300468","article-title":"Complete or Culprit-Only PCI in Older Patients with Myocardial Infarction","volume":"389","author":"Biscaglia","year":"2023","journal-title":"N. Engl. J. Med."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"2713","DOI":"10.1016\/j.jacc.2019.09.051","article-title":"Timing of Staged Nonculprit Artery Revascularization in Patients with ST-Segment Elevation Myocardial Infarction: COMPLETE Trial","volume":"74","author":"Wood","year":"2019","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"264","DOI":"10.1016\/j.jacc.2015.10.082","article-title":"Single-Staged Compared with Multi-Staged PCI in Multivessel NSTEMI Patients: The SMILE Trial","volume":"67","author":"Sardella","year":"2016","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1368","DOI":"10.1056\/NEJMoa2307823","article-title":"Timing of Complete Revascularization with Multivessel PCI for Myocardial Infarction","volume":"389","author":"Stahli","year":"2023","journal-title":"N. Engl. J. Med."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1172","DOI":"10.1016\/S0140-6736(23)00351-3","article-title":"Immediate versus staged complete revascularisation in patients presenting with acute coronary syndrome and multivessel coronary disease (BIOVASC): A prospective, open-label, non-inferiority, randomised trial","volume":"401","author":"Diletti","year":"2023","journal-title":"Lancet"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"237","DOI":"10.1093\/eurheartj\/ehy462","article-title":"Fourth universal definition of myocardial infarction (2018)","volume":"40","author":"Thygesen","year":"2019","journal-title":"Eur. Heart J."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"737","DOI":"10.1016\/S0140-6736(17)31490-3","article-title":"Optimal timing of an invasive strategy in patients with non-ST-elevation acute coronary syndrome: A meta-analysis of randomised trials","volume":"390","author":"Jobs","year":"2017","journal-title":"Lancet"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1115","DOI":"10.1056\/NEJMoa1305520","article-title":"Randomized trial of preventive angioplasty in myocardial infarction","volume":"369","author":"Wald","year":"2013","journal-title":"N. Engl. J. Med."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"963","DOI":"10.1016\/j.jacc.2014.12.038","article-title":"Randomized trial of complete versus lesion-only revascularization in patients undergoing primary percutaneous coronary intervention for STEMI and multivessel disease: The CvLPRIT trial","volume":"65","author":"Gershlick","year":"2015","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1234","DOI":"10.1056\/NEJMoa1701067","article-title":"Fractional Flow Reserve-Guided Multivessel Angioplasty in Myocardial Infarction","volume":"376","author":"Smits","year":"2017","journal-title":"N. Engl. J. Med."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"625","DOI":"10.1056\/NEJM199908263410901","article-title":"Early revascularization in acute myocardial infarction complicated by cardiogenic shock. SHOCK Investigators. Should We Emergently Revascularize Occluded Coronaries for Cardiogenic Shock","volume":"341","author":"Hochman","year":"1999","journal-title":"N. Engl. J. Med."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"2347","DOI":"10.1016\/j.jcin.2023.07.043","article-title":"Complete Percutaneous Coronary Revascularization in Acute Coronary Syndromes with Multivessel Coronary Disease: A Systematic Review","volume":"16","author":"Faro","year":"2023","journal-title":"JACC Cardiovasc. 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