**1. Introduction**

The current guidelines recommend culprit vessel revascularization as a standard treatment option in primary percutaneous coronary intervention (PPCI) [1–6]. Nevertheless, patients with ST‐segment elevation myocardial infarction (STEMI) and multivessel coronary artery disease (MVCAD) constitute up to 50% of all STEMI cases [7, 8]. As known, MVCAD is asso‐ ciated with an adverse short‐ and long‐term outcome after STEMI [9–11]. The definition and criteria of MVCAD, timing for nonculprit vessel revascularization, and a number of other tac‐ tical issues are actively discussed in the recent literature [5, 6]. There are three established PCI approaches for treatment of MVCAD and STEMI: (1) PPCI of infarct‐related artery (IRA) only (culprit vessel revascularization only, CO) with percutaneous coronary intervention (PCI) of noninfarct‐related artery based on findings ischemia (spontaneous or during noninvasive

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stress‐testing); (2) multivessel primary stenting (MPS): IRA is opened with the further dilata‐ tion of other significantly narrowed arteries during the same PPCI procedure; (3) multivessel staged stenting (MSS): the IRA only is treated during the first PPCI procedure with subse‐ quent complete revascularization during the second intervention. In this chapter, we justify the use of personalized approach for the optimal revascularization strategy in patients with STEMI and MVCAD using the latest generation of drug‐eluting stents (DES) with choosing MPS or MSS according to our original calculator. The chapter includes theoretical rationale, original single‐center study, an original calculator for choosing optimal revascularization strategy, and a clinical case example.
