New Paradigm of Complete Revascularization in Acute Coronary Syndrome with Multivessel Coronary Artery Disease: Is it Reasonable in Clinical Practice?

Background: Coronary artery disease is the leading cause of illness and death in older adults. Around 40% to 50% of patients with ST-segment elevation myocardial infarction (STEMI) have multiple coronary artery disease. Multiple vessel coronary disease has been shown to improve cardiac outcomes and survival in patients who have undergone complete revascularization (CR) versus patients who have undergone only incomplete revascularization (ICR). Objective: In this review, we discussed the benefit of complete revascularization in acute coronary syndrome (ACS) patients with multivessel disease and which patient can be performed aggressive revascularization to achieved CR in clinical practice. Discussion: When coronary angiography and PCI of the source of the infarction are performed on patients with ACS, the risk of adverse cardiac death or myocardial infarction is significantly reduced. Additional research is needed to determine the efficacy of PCI in non-critical lesions. However, following procedures such as CABG or PCI, these procedures may be impossible to perform due to a variety of personal, anatomical, technical, and logistical barriers. Conclusion: In order to make a clinical decisions, lesions need to be evaluated as well as several variables, such as patient behavior, cardiovascular health, and other factors also have to be considered. CR has been demonstrated in several studies to result in decreased rehospitalization and the need for repeated revascularization in the subsequent period in ACS patients with a low SYNTAX score and no cardiogenic shock.