ST elevation myocardial infarction and multi-vessel coronary artery disease: complete or incomplete revascularisation?

The most recent guidelines for the treatment of ST elevation myocardial infarction strongly support a prompt mechanical reopening of the occluded culprit coronary artery. However, there is a great debate regarding how to treat the bystander non-culprit coronary artery disease. While data from retrospective studies and registries suggest that it should be treated in a second-staged procedure, a recent randomised study has suggested a better outcome for patients receiving complete revascularisation during the index primary PCI. In this paper we aim to address this controversial point, analysing the most recent and important scientific publications and trying to give a personal point of view according to the clinical practice in our institution.