Approximately 50% of patients with ST-segment elevation myocardial infarction (STEMI) have multivessel disease. The optimal reperfusion strategy in these patients is still uncertain. Whether percutaneous coronary intervention (PCI) of only the culprit vessel or a strategy of complete revascularization, either in a simultaneous or staged multivessel PCI approach, should be performed remains unclear. Although a large number of observational studies have mostly shown worse clinical outcomes associated with a multivessel PCI approach, increasing evidence from randomized controlled trials suggests that multivessel PCI is safe, while reducing the need for revascularization in selected patients, compared with culprit vessel-only PCI. However, adequately-powered studies are still needed to determine the best treatment strategy in patients with STEMI and multivessel disease, particularly to demonstrate a reduction in the hard end point of death or myocardial infarction. In this Review, we provide a comprehensive summary of current evidence on the different treatment options for patients with STEMI and multivessel disease, highlighting current guideline recommendations and providing future directions on reperfusion strategies in these patients.

大约50％的ST段抬高型心肌梗死（STEMI）患者患有多支血管疾病。这些患者的最佳再灌注策略仍不确定。目前尚不清楚是采用同时或分阶段的多支血管介入治疗方法进行仅对罪犯血管进行经皮冠状动脉介入治疗（PCI）或完全血运重建的策略。尽管大量观察性研究大多显示了与多支血管介入治疗相关的临床结局较差，但随机对照试验中越来越多的证据表明，与仅使用罪犯血管的PCI相比，多支血管介入治疗是安全的，同时减少了部分患者的血运重建需求。然而，为了确定STEMI和多支血管疾病患者的最佳治疗策略，仍然需要进行充分的研究，尤其是要证明死亡或心肌梗塞的硬性终点降低。在本综述中，我们提供了关于STEMI和多支血管疾病患者不同治疗选择的最新证据的综合摘要，重点介绍了当前的指南建议，并为这些患者的再灌注策略提供了未来的方向。