How Should You Treat/Assess Non-culprit Disease? - Dr. Justin Davies

Summary

Justin Davies details the assessment and treatment of bystander CAD in ACS

• The negative prognostic impact of multi vessel disease in STEMI
• Theoretical pros and cons of both treating and deferring non-culprit vessels in ACS
• The concept of "vulnerable plaque"
• Previous guidelines recommendations strongly discouraged treating non-culprit arteries in STEMI (class III recommendation in 2013); now upgraded to Class IIb
• Summary of RCT evidence available on this topic: PRAMI, CvLPRIT, DANAMI
• Intracoronary imaging with IVUS and OCT to characterise plaque composition, vessel characteristics and luminal area
• Future RCTs currently ongoing that will provide more data to guide us in this field