Culprit only versus multivessel coronary revascularization in patients presenting with acute ST elevation myocardial infarction: Unending debate

The optimal percutaneous interventional strategy for dealing with significant non-culprit lesions in patients with multivessel disease with acute myocardial infarction (AMI) at presentation remains to be controversial. For the time being, the current guidelines recommended that primary percutaneous coronary intervention (PCI) for non-culprit lesions should be limited to the infarct-related artery. We believe that decisions about PCI of the non-infarct vessel(s) should be individualized and guided by objective evidence of significant residual ischemia except in patients with multivessel disease showing hemodynamic compromise. Further large, randomized trials will help us solve this dilemma.