ACUTE CORONARY SYNDROME IN PATIENTS WITH MULTIVASCULAR DISEASE: WHEN IS THE IDEAL TIME TO TREAT RESIDUAL LESIONS?

Abstract

Acute coronary syndromes (ACS) remain among the leading causes of morbidity and mortality worldwide, frequently associated with multivessel coronary artery disease. In this context, a significant proportion of patients present with stenoses in vessels unrelated to the acute event, making the management of residual lesions a central element in risk stratification and therapeutic definition. This study aimed to review the available evidence regarding the ideal timing for the treatment of these lesions in patients with ACS. This is a narrative literature review conducted in the Medline database, covering the period from 2016 to 2026, with an initial identification of 343 articles, of which 30 were selected after applying eligibility criteria and qualitative analysis. The analyzed studies demonstrate that the complete revascularization strategy is associated with a reduction in major cardiovascular events, including death, reinfarction, and the need for further interventions, when compared to treatment restricted to the culprit artery. Regarding the timing of the intervention, more recent evidence indicates that immediate complete revascularization presents comparable efficacy and safety to the staged strategy, without a significant increase in adverse events. Additionally, approaches guided by physiological or imaging methods suggest that different strategies can be safely adopted, although with variations in the intervention rate and specific outcomes. Therefore, it is concluded that, although complete revascularization is the preferred strategy, the ideal timing for the treatment of residual lesions can be individualized, considering clinical, anatomical, and logistical characteristics, without compromising prognosis, reinforcing the importance of clinical judgment in decision-making.