Nonculprit Lesions - Innocent or Guilty by Association

The identification and treatment of the infarct-artery (or culprit) lesion is the primary goal of percutaneous coronary intervention (PCI) in patients with acute ST-segment elevation myocardial infarction (STEMI). Expeditious coronary stenting of the thrombosed artery stems ongoing myocardial necrosis and prevents recurrent infarction and death. During emergency angiography and intervention, the focus is on a single thrombotic site. Other plaques may be identified that may be severe but are not thrombotic and so are considered innocent. These stenoses become targets for medical prevention but not coronary stenting. Wald et al. now report in the Journal the results of the Preventive ...