• Pieter C Smits, Amira Assaf, Gert Richardt, Elmir Omerovic, Mohamed Abdel-Wahab, and Franz-Joseph Neumann.
• Maasstad Ziekenhuis, Rotterdam, the Netherlands. Electronic address: smitsp@maasstadziekenhuis.nl.
• Am. Heart J. 2017 Apr 1; 186: 21-28.

AbstractWhat the best strategy is for nonculprit lesions in ST-elevation myocardial infarction (STEMI) patients presenting with multivessel disease remains a clinical dilemma. Based on recent clinical studies suggesting that complete revascularization in the acute phase is beneficial, the European Society of Cardiology and American College of Cardiology/American Heart Association guidelines have been recently changed from class 3 discouragement to a class 2B recommendation concerning the treatment of the nonculprit lesions in the acute index procedure. However, in these recent studies, nonculprit lesion treatment was guided by angiography, which is known for its poor accuracy in determining ischemia. Fractional flow reserve (FFR) guidance for treatment of nonculprit vessels seems to be a reasonable approach, and in the acute setting of STEMI, it is not yet investigated. The COMPARE-ACUTE trial aims to investigate FFR-guided complete revascularization in comparison to a culprit lesion treatment-only strategy in STEMI patients with multivessel disease presenting for primary percutaneous coronary intervention.Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

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