Complete Percutaneous Coronary Revascularization in Acute Coronary Syndromes With Multivessel Coronary Disease

Multivessel disease (MVD) affects approximately 50% of patients with acute coronary syndromes (ACS) and is signifi-cantly burdened by poor outcomes and high mortality. It represents a clinical challenge in patient management and decision making and subtends an evolving research area related to the pathophysiology of unstable plaques and local or systemic inflammation. The benefits of complete revascularization are established in hemodynamically stable ACS pa-tients with MVD, and guidelines provide some reference points to inform clinical practice, based on an evidence level that is solid for ST-segment elevation myocardial infarction and less robust for non-ST-segment elevation myocardial infarction and cardiogenic shock. However, several areas of uncertainty remain, such as the optimal timing for complete revascularization or the best guiding strategy for intermediate stenoses. We performed a systematic review of current evidence in the field of percutaneous revascularization in ACS and MVD, also including future perspectives from ongoing trials that will directly compare different timing strategies and investigate the role of invasive and noninvasive guidance techniques. (Complete percutaneous coronary revascularization in patients with acute myocardial infarction and multi -vessel disease; CRD42022383123) (J Am Coll Cardiol Intv 2023;16:2347-2364) (c) 2023 by the American College of Cardiology Foundation.