3
➤ Staged percutaneous intervention (while in hospital or after
discharge) of a significantly stenosed non-culprit artery in patients
presenting with an ST-segment-elevation myocardial infarction is
recommended in select patients to improve outcomes. Percutaneous
intervention of the non-culprit artery at the time of primary
percutaneous coronary intervention is less clear and may be
considered in stable patients with uncomplicated revascularization
of the culprit artery, low-complexity non-culprit artery disease, and
normal renal function. In contrast, percutaneous intervention of the
non-culprit artery can be harmful in patients in cardiogenic shock.
➤ Revascularization decisions in patients with diabetes and multivessel
coronary artery disease are optimized by the use of a Heart Team
approach. Patients with diabetes who have triple-vessel disease should
undergo surgical revascularization; percutaneous coronary intervention
may be considered if they are poor candidates for surgery.
➤ Treatment decisions for patients undergoing surgical
revascularization of coronary artery disease should include the
calculation of a patient's surgical risk with the Society of Thoracic
Surgeons score. The usefulness of the SYNTAX score calculation
in treatment decisions is less clear because of the interobserver
variability in its calculation and its absence of clinical variables.
