A new study suggests complete revascularization (CR) is linked to significantly improved outcomes in the treatment of patients who experience heart attack with multivessel disease (MVD). Published in JACC: Cardiovascular Interventions, the study concludes that in patients with ST-segment elevation myocardial infarction (STEMI) and MVD, the implementation of CR and physiology-guided procedures increased over time. As of 2021, 51% of patients underwent CR and 14% physiology-guided CR as the research team stated that the procedure, whether angiographically or physiologically guided, was independently associated with favorable outcomes, including mortality. Younger patients “CR and/or physiology measures to guide revascularization were more likely used in younger patients with more extensive coronary disease but fewer comorbidities and less severe clinical presentation,” said the paper’s authors, led by Felix Lindberg, MD, PhD, from the Karolinska Institutet in Stockholm, Sweden. The study looked at over 20,000 patients in the national SWEDEHEART registry treated for ST-segment elevation myocardial infarction (STEMI) between 2009 and 2021. The research team found that the use of CR increased from 33% in 2009 to 51% in 2021. This includes both angiographic CR and physiology-guided CR, with the latter rising from 0% in 2009 to 14% in 2021. CR was associated with a lower risk of death, repeat heart attack or unplanned revascularization. Compared with incomplete revascularization (IR), angiographic CR reduced the adjusted risk of these outcomes by 16% (adjusted hazard ratio [HR]: 0.84; 95% confidence interval [CI]: 0.79–0.89), while physiology-guided CR reduced the risk by 20% (adjusted HR: 0.80; 95% CI: 0.69–0.93). PRAMI trial “The sharpest increase in CR use followed the publication of the Preventive Angioplasty in Acute Myocardial Infarction (PRAMI) trial,” said the authors of the paper. “This shift preceded subsequent upgrades of guideline recommendations in favor of CR, indicating early adoption of emerging evidence.” In an accompanying editorial, Francis R. Joshi, MBBS, PhD, praised the progress toward CR in patients with ST-segment elevation myocardial infarction (STEMI) and multivessel disease (MVD), while highlighting critical gaps in clinical practice. He added that although an increase in complete revascularization over time was observed, even in 2021, nearly one-half of patients were left incompletely revascularized. He warned that the complexity of patient cases often influenced treatment decisions. “Patients with comorbidity and more complex disease… are left incompletely revascularized, despite the evidence to suggest that they have poorer outcomes,” Dr. Joshi said. He highlighted that operator judgment, clinical time constraints, and lack of documentation on decision-making may contribute to inconsistent care. “…the onus is on us to support trials… and enroll patients who better reflect those we treat every day,” he concluded. Sources: Lindberg F, Mogensen B, Buccheri S, et al. Revascularization Strategies in ST-Segment Elevation Myocardial Infarction With Multivessel Disease: Temporal Trends, Patient Profiles, and Outcomes. JACC Cardiovasc. Interv. 2025;18: 1246–1259. Joshi FR. Making Progress Toward Complete Revascularization of Multivessel Disease After STEMI. JACC Cardiovasc. Interv. 2025;18:1260–1262. Image Credit: fizkes – stock.adobe.com