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Cardiac Imaging and Diagnostics · Journal article
Coronary Artery Disease · July 9, 2026
A consensus or society position rather than new primary data.
This narrative review synthesizes emerging evidence challenging the European Society of Cardiology guideline recommendation for routine immediate complete revascularization in hemodynamically stable STEMI patients with multivessel disease. Recent randomized trials report heterogeneous results, with some supporting immediate revascularization safety and others raising concerns in reduced ejection fraction, while a novel trial demonstrates comparable long-term outcomes using staged physiology-guided PCI with substantially fewer interventions.
Narrative review article. STEMI patients with multivessel coronary artery disease, particularly hemodynamically stable patients; includes subgroups with impaired cardiac function..
Nearly half of all STEMI patients present with multivessel coronary artery disease Current ESC guidelines advocate routine complete revascularization within 45 days in all hemodynamically stable patients Recently published trials show heterogeneous and conflicting results on timing of non-culprit lesion PCI
Safety was not reported in the material analysed. Check the source before drawing any conclusion about harm.
Clinicians should recognize that the evidence base for routine immediate complete revascularization in all STEMI patients with multivessel disease is now contested. Recent trials support a shift toward individualized, physiology- and imaging-guided staged approaches, particularly in patients with reduced ejection fraction, though the optimal selection criteria require clarification.
A narrative review synthesizing recent trial evidence on STEMI multivessel disease management, acknowledging conflicting results and proposing a shift in clinical paradigm toward individualized physiology-guided approaches rather than routine immediate complete revascularization.
As stated by the source record.
Quoted from the source exactly as published.
Clinicians should recognize that the evidence base for routine immediate complete revascularization in all STEMI patients with multivessel disease is now contested. Recent trials support a shift toward individualized, physiology- and imaging-guided staged approaches, particularly in patients with reduced ejection fraction, though the optimal selection criteria require clarification.
Graded across the dimensions that decide whether you should act, each from what the source actually supports. There is no single score, and where a dimension was not assessed it says so.
Primary percutaneous coronary intervention (PCI) of the culprit lesion is the preferred treatment in ST-segment elevation myocardial infarction (STEMI). However, in nearly half of all patients, multivessel coronary artery disease is present, raising fundamental questions: should non-culprit lesions be treated at all, and if so, should revascularization be performed immediately or in a staged fashion? Furthermore, should lesion selection be guided by angiography or by functional and imaging-based assessment? Over the past decade, landmark trials shifted clinical practice and formed the basis for current guideline recommendations of the European Society of Cardiology, advocating routine complete revascularization within 45 days in all hemodynamically stable patients. Yet, recently published evidence has challenged this paradigm. New randomized trials exploring the timing and guidance of non-culprit lesion PCI have yielded heterogeneous and, at times, conflicting results. While some suggest that immediate complete revascularization is safe, others raise concerns in patients with impaired cardiac function. Another recently published trial introduces a novel concept by directly comparing immediate physiology-guided PCI with a staged, noninvasive ischemia-guided strategy, demonstrating similar long-term outcomes with substantially fewer interventions. Together, these findings are reshaping the current view of the management of multivessel disease in STEMI. The metaphoric 'therapeutic pendulum' - after swinging firmly towards immediate complete revascularization - is beginning to swing back towards a more individualized, physiology- and imaging-based approach. The central aim of this review is to evaluate whether this individualized staged physiology- and imaging-based approach is a valid alternative to immediate complete revascularization. Clarifying which patients truly benefit from immediate complete revascularization remains a pivotal challenge for future clinical research and guideline development.
Taken from the source record, never inferred. Follow any of these and new work involving them reaches your briefing.