Angiography- vs. physiology-guided complete revascularization in patients with ST-elevation myocardial infarction and multivessel disease: who is the better gatekeeper in this setting? A meta-analysis of randomized controlled trials

Following an ST-elevation myocardial infarction (STEMI), a heightened predisposition to atherothrombotic events may persist for years.1 A growing body of evidence supports the prognostic value of complete over culprit-lesion-only revascularization among patients with STEMI and multivessel coronary artery disease (CAD).2,3 Whether the degree of angiographic obstruction or haemodynamical significance of a stenosis is a better marker to predict the evolution of a plaque towards clinically manifest atherothrombosis is unclear. Thus, which is the best between an angiography- vs. physiology-guided strategies to drive revascularization of non-culprit lesions following STEMI to prevent myocardial infarction (MI) and associated cardiovascular death (CVD) remains undefined. .....