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Lawton et al 2021 ACC/AHA/SCAI Coronary Revascularization Guideline

CLINICAL STATEMENTS AND GUIDELINES

Circulation. 2022;145:e18–e114. DOI: 10.1161/CIR.0000000000001038 January 18, 2022

Figure 4. Revascularization of Noninfarct-Related Coronary Artery Lesions in Patients With STEMI. Colors correspond to Table 2. CABG indicates coronary artery bypass graft; GDMT, guideline-directed medical therapy; PCI, percutaneous coronary intervention; and STEMI, ST-segment–elevation myocardial infarction. *Normal blood pressure and heart rate left ventricular end-diastolic pressure <20 mm Hg, no chronic renal insufficiency or acute kidney injury, and expected total contrast volume <3× glomerular filtration rate, simple lesion anatomy. †In making the decision about the need for and mode of revascularization the Heart Team should consider the suitability of the non-culprit artery for PCI, the coronary complexity and the risk of revascularization, the extent of myocardium at risk, and patient comorbidities, including life expectancy or other significant patient comorbidities, such as chronic renal insufficiency or acute kidney injury. ‡Staged PCI can be performed in hospital or after discharge, up to 45 days post MI.

Symbol denotes time elapsed before proceeding to the next procedure. This algorithm summarizes the recommendations in this guideline for the care of patients with STEMI and noninfarct artery disease. It is not meant to encompass every patient scenario or situation, and clinicians are encouraged to use a Heart Team approach when care decisions are unclear and to see the accompanying supportive text for each recommendation. Additionally, in situations that lack sufficient data to make formal recommendations for care, please see Section 17, “Unanswered Questions and Future Directions.”

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