Physiology-guided vs Angiography-guided Non-culprit Lesion Complete Revascularization for Acute MI & Multivessel Disease

Inclusion Criteria:

1. Patients presenting with STEMI or type 1 NSTEMI and within 72 hours of successfulculprit-lesion PCI

2. Residual coronary artery disease defined as at least 1 additionalnon-infarct-related coronary artery stenosis that meets all of the followingcriteria:

3. Amenable to successful treatment with PCI

4. At least 50% diameter stenosis by visual estimation

5. At least 2.5 mm in diameter

6. Planned complete revascularization strategy for qualifying MI

Exclusion Criteria:

1. Planned or prior coronary artery bypass graft (CABG) surgery

2. Inability to clearly identify a culprit lesion for STEMI or NSTEMI based onangiographic appearance and/or ECG changes and/or regional wall motion abnormalities

3. Prior PCI of a non-culprit lesion in a different vessel from the culprit lesionwithin 45 days of randomization

4. Planned medical treatment of all qualifying non-culprit lesions (i.e., no PCI)

5. Presence of severe non-culprit-lesion stenosis with reduced epicardial flow (TIMIflow ≤ 2) or >90% visual diameter stenosis

6. Presence of a chronic total occlusion (CTO) if it is the only qualifying non-culpritlesion (patients with a CTO plus additional qualifying non-culprit lesions areeligible)

7. The only qualifying non-culprit lesion is in the same vessel territory as theculprit lesion

8. Baseline STEMI or NSTEMI was due to a suspected non-atherothrombotic mechanism suchas type 2 MI (supply-demand mismatch), including spontaneous coronary arterydissection or coronary artery embolism

9. Non-cardiovascular co-morbidity with expected life expectancy <2 years

10. Any other medical, geographic, or social factor making study participationimpractical or precluding 5 year follow-up