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Multivessel Coronary Artery Disease

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Abstract

Among patients with stable ischemic heart disease (SIHD), multivessel disease (MVD) is not uncommon. Moreover, a greater number of vessel stenosis or occlusions sequentially portends a worse prognosis. The optimal treatment for SIHD is a topic of ongoing debate, and a number of important clinical characteristics must be considered prior to deciding on a management strategy. The treatment goals in patients with MVD are to: (1) improve survival and/or (2) relieve symptom burden. Approximately 50% of patients suffering an ST-elevation myocardial infarction (STEMI) have significant MVD, or non-culprit lesions. These patients have worse outcomes due to higher mortality and increased risk of recurrent MI when compared with patients with single-vessel disease. The recommendations for culprit-only PCI versus complete or staged revascularization in the setting of STEMI are dynamic, and have been an ongoing area of controversy, in large part secondary to the lack of adequately powered trials to assess important clinical endpoints. Based on the current literature and guidelines, in the case of STEMI with evidence of concomitant severe non-culprit lesions, there are multiple approaches available to the interventional cardiologist.

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Authors and Affiliations

  1. The Leon H. Charney Division of Cardiology, New York University School of Medicine, New York, NY, USA

    Mina Owlia & Sripal Bangalore

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  1. Mina Owlia
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  2. Sripal Bangalore
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Editors and Affiliations

  1. Brighton and Sussex Medical School and the Sussex Cardiac Centre, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK

    Aung Myat

  2. Royal Papworth Hospital NHS Foundation Trust, Papworth Everard, Cambridge, UK

    Sarah Clarke

  3. Wessex Cardiothoracic Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK

    Nick Curzen

  4. Department of Cardiology, Bern University Hospital, Bern, Switzerland

    Stephan Windecker

  5. Inova Center for Thrombosis Research and Drug Development, Inova Heart and Vascular Institute, Falls Church, VA, USA

    Paul A. Gurbel

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Owlia, M., Bangalore, S. (2018). Multivessel Coronary Artery Disease. In: Myat, A., Clarke, S., Curzen, N., Windecker, S., Gurbel, P.A. (eds) The Interventional Cardiology Training Manual. Springer, Cham. https://doi.org/10.1007/978-3-319-71635-0_29

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