Gated-SPECT in the Planning of Ischemia Guided PCI in STEMI Patients

Primary percutaneous coronary intervention (PPCI) is the standard of care for ST-segment elevation myocardial infarction (STEMI), when performed by experienced groups in a timely manner. Although initial observational studies have shown conflicting results, evidence from four randomized controlled trials suggests that a post-primary percutaneous intervention (PPCI) strategy of staged PCI of the non-culprit vessel(s)  is beneficial and safe in STEMI patients. Importantly, for this application, issues related to the evaluation of ischemia in the STEMI patient with multivessel coronary artery disease (CAD) focusing on PCI in the non-culprit lesion have not been fully addressed. When considering that 40-70% of STEMI patients have multivessel disease, alternative approaches for post-PPCI non-culprit lesion intervention need to be considered. The current application proposes a primary objective of applying gated-SPECT MPI as a guide to post-PPCI non-culprit coronary lesion intervention as compared to standard approaches which use post-PPCI intervention of all non-culprit lesions (based on anatomy alone).  The successful completion of this protocol will help establish the value of gated-SPECT MPI protocol with pharmacological stress to guide efficacious multivessel PCI in STEMI patients.