Acute coronary syndromes in patients with multivessel disease: the key role of optical coherence tomography

In this article, we provide very illustrative images obtained with optical coherence tomography (OCT) of a patient presenting with ST-elevation myocardial infarction and multivessel disease. These patients are referred to the catheterization laboratory without performing any prior noninvasive imaging. This leads very often to diagnostic dilemmas with difficult solutions. Coronary angiography is frequently insufficient or even misleading to guide the interventional cardiologist in the identification and revascularization of the culprit coronary lesion. What makes our case particularly paradigmatic is the fact that without OCT guidance, an erroneous clinical decision-making process would have taken place, leaving untreated the culprit lesion in this patient.