Value of gated-SPECT MPI for ischemia-guided PCI of non-culprit vessels in STEMI patients with multivessel disease after primary PCI

There remains a clinical question of which patients benefit from revascularization of non-culprit coronary artery stenosis in the setting of acute st-segment elevation myocardial infraction (stemi). this is a large population of patients with prior studies showing 40 to 70% of patients with stemi having non-culprit stenosis. this article reviews the current state of the literature evaluating outcomes of those previously randomized to revascularization of non-culprit stenosis around the time of the stemi. we propose a new study design to utilize gated-spect in the decision process by using an ischemic burden of > 5% as a cut-off for revascularization vs. complete revascularization without ischemia assessment.