Complete or Partial Revascularization During Emergency PCI in a Patient With NSTEMI

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.