Dr Peter Ong from the Robert-Bosch Hospital in Stuttgart, Germany, speaks to Cardio Debate & Radcliffe Cardiology about the treatment of patients with STEMI and multivessel disease, during the ESC2016 Congress held in Rome, Italy.
There has been controversy in the treatment strategy in STEMI and MVD in patients. Could you summarise this?
The main controversy in these patients is the studies that have been published so far did not compare guideline-recommended approach in these patients with multi-vessel; PCI at the time of primary PCI.
All the studies had a control group that had only revascularization of the culprit lesion, but not the staged approach as is currently recommended.
What is the appropriate timing to tackle the culprit and other severe lesions of this patient population?
Of course if a patient is in cardiogenic shock then all lesions should be treated at the time of primary PCI. But if the patient is not in cardiogenic shock, then we usually wait two to three days until we do non-invasive ischaemia imaging, and then only proceed with another PCI if imaging shows area of ischaemia.
Is there any ongoing research that cardiologists should be aware of?
Yes. Currently there is a study led by Holger Thiele from Lübeck/Germany, who is actually doing a study where the guideline-recommended approach is compared to multi-vessel PCI at the time of primary PCI, so that is something we would be interested in in the future.