• Coronary artery disease
• PCI
• STEMI
• coronary angioplasty

The prevalence of multivessel disease in patients presenting with acute ST-segment elevation myocardial infarction (STEMI) approaches 40%.1 The conventional strategy for coronary angioplasty (primary percutaneous coronary intervention, PPCI) in the setting of STEMI usually involves selective intervention to the infarct-related artery (IRA), or culprit-only revascularisation (COR), with treatment being deferred for significant non-infarct-related lesions (N-IRA) in those patients with multivessel disease.2 This may be either performed as a later staged PCI procedure (staged revascularisation, SR), or postponed indefinitely pending non-invasive assessment of ischaemia and/or symptoms.

Currently, there is no consensus on the optimal management of significant N-IRA lesions. Previously non-randomised comparisons have been made between ‘complete’ revascularisation (CR) with multivessel PCI at the time of PPCI and culprit-only PCI (COR). However, the definitive strategy is still undetermined and the subsequent management of any N-IRA lesions is largely left to operator discretion. Consequently, there is vast heterogeneity in treatment; some routinely do the ‘significant-other’ lesion during that patient's hospital stay, while others perform a non-invasive test to demonstrate the presence of ongoing ischaemia as a means to determine if further revascularisation is indicated.