Clinical Significance of Non-IRA Disease in STEMI Patients

February 4th, 2015

Clinical Significance of Non-IRA Disease in STEMI Patients

Beat J. Meyer, M.D.

This post is adapted from Dr. Meyer’s NEJM Journal Watch summary of an article recently published in the Journal of the American Medical Association.

Recent findings from a very large dataset suggest that obstructive non–infarct-related artery (IRA) disease is common among patients with STEMI and associated with increased mortality. Whether non-IRA lesions should be treated directly during the index admission, by a staged procedure 4 to 6 weeks later, or with optimal medical therapy (as suggested by the COURAGE trial) is a controversy that this study does not resolve. Unfortunately, the setting in which this decision takes place does not lend itself well to shared decision making with the patient — and as long as the decision is based on the opinion of any particular doctor, variations in clinical practice are likely to persist. Moreover, unless better invasive and noninvasive markers are identified to allow more-reliable identification of individual CAD progression (i.e., plaque burden and individual vulnerability), most physicians will continue to rely on coronary angiography findings for their management decisions, despite modest clinical benefits and increased costs.

What strategy do you currently favor for managing obstructive non-IRA lesions? Are these new findings likely to change your approach?

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CardioExchange, an NEJM practice community for medical professionals dedicated to improving cardiac patient care, was active from 2009 to 2015. CardioExchange fostered discussion between clinicians from across the globe.

February 4th, 2015