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In patients presenting with ACS and multivessel disease, when do you favor immediate versus delayed complete revascularization?

If delayed complete revascularization is favored, would you consider staged PCI during that same admission or PCI outpatient?
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In hemodynamically stable patients presenting with STEMI and multivessel disease, do you favor immediate or delayed complete revascularization? If delayed complete revascularization is preferred, how long do you wait before staged PCI?

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4 Answers
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Cardiology · ETSU Health Care
Answered on

My approach is to defer the PCI to a few weeks (as outpatient) as long as the patient is asymptomatic and does not have a critical lesion (i.e. greater than 90% stenosis in the proximal LAD, LCX or RCA).

I have been very consistent with this approach and I recall one patient who came back with unst...

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Cardiology · Michael D Moran Md Inc
Answered on

So we are all sitting here answering this question with years of training and experience, and patients are somehow going to magically know the medical issues and cardiac issues to make an informed decision? Is this decision based on financial considerations? Do what your training, experience, and st...

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Cardiology · Yale New Haven Health-Bridgeport Hospital
Answered on

While several trials have shown the long-term benefit of complete revascularization after STEMI in hemodynamically stable patients, The MULTISTARS AMI trial addressed this very question. Over 800 hemodynamically stable patients with STEMI and multivessel CAD were randomized to immediate multivessel ...

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Cardiology · Interventional cardiologist
Answered on · Updated on

The COMPLETE trial looked at this very question and now COMPLETE 2 is similarly looking at this question with all ACS patients.

PCI of the non-infarct related vessel can safely be performed during the index hospitalization or within the first six weeks after discharge.

Contrast-related renal issues, L...

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