JACC Case Rep. 2026 Jan 30:106792. doi: 10.1016/j.jaccas.2025.106792. Online ahead of print.
ABSTRACT
BACKGROUND: Optimal management of nonculprit lesions remains uncertain in patients with non-ST-segment elevation myocardial infarction (NSTEMI) during emergency percutaneous coronary intervention (PCI).
CASE SUMMARY: An NSTEMI patient underwent emergency PCI for electrocardiogram-indicated culprit lesion only. His nonculprit lesion progressed to asymptomatic total occlusion in 5 days despite medical therapy.
DISCUSSION: This case highlights that in NSTEMI patients: 1) symptom resolution does not guarantee lesion stability; 2) complete revascularization should be considered for all unstable lesions during emergency PCI; and 3) intravascular imaging is useful to help identify unstable lesions during emergency PCI.
TAKE-HOME MESSAGE: Combine all symptoms, electrocardiographic findings, angiographic characteristics, and intravascular imaging to help identify and treat unstable lesions during emergency PCI in NSTEMI patients.
PMID:41615345 | DOI:10.1016/j.jaccas.2025.106792