In patients with ST elevation myocardial infarction (STEMI) the treatment goal is
revascularization of the occluded artery with the use of primary percutaneous coronary
intervention (PCI). There is a large subset of patients with STEMI who also have significant
disease in arteries other than the site of occlusion, and away from the culprit artery. It is
estimated that up to 50% have disease of more than 50% in the non-culprit arteries.
The evidence on how to treat those patients with multi vessel disease is conflicting. Earlier
large-scale studies and registries have suggested early and complete revascularization is of
no benefit or even harmful. More recent studies have showed the opposite of that. The CVLPRIT
study showed that early complete revascularization or preventive PCI reduced primary endpoint
of a composite of all cause mortality, myocardial infarction and need for repeat
revascularization. The benefit was mainly due to reduced repeat revascularization in the more
intensive intervention group. The PRAMI study showed very similar results as well.
The use of Fractional flow Reserve (FFR) in deciding complete revascularization has also
showed conflicting results so far. A previous trial showed that FFR guided intervention post
STEMI increased MACE. This was conflicted with more recent study, which showed FFR guided
complete revascularization improved outcome when compared with more conservative treatment of
ischaemia driven intervention.
In this study, the investigators are going to assess the issue of staged revascularization
guided by FFR or by angiogram, compared to the standard treatment of ischaemia driven