Timing and selection of the type of revascularization procedure in acute coronary syndrome without ST-segment elevation with multivessel coronary artery disease
Abstract
Most patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS) are treated with success by early percutaneous coronary intervention (PCI). In patients with multivessel coronary artery disease, selection of proper timing and type of revascularization procedure may prove to be difficult.
Critical considerations in this context include the patient's clinical status, their risk profile, nature, and extent of coronary involvement. The pivotal role in this process is played by the interventional cardiologist assessing the findings on the coronary arteries.
Any attempted treatment of the culprit lesion may significantly affect the type of revascularization eventually employed. In some patients, an alternative to PCI and surgical revascularization is a hybrid procedure.
Data from large registries suggest surgical revascularization in stable patients after NSTE-ACS should be preferably deferred by at least a week. No randomized studies addressing the optimal revascularization strategy in these patients have apparently been published to date.