Background Few reports described outcomes of complete compared with infarct-related artery (IRA)-only revascularisation in patients with ST-elevation myocardial infarction (STEMI) and multivessel coronary artery disease (CAD). Moreover, no studies have compared the simultaneous treatment of non-IRA with the IRA treatment followed by an elective procedure for the other lesions (staged revascularisation). Methods The outcomes of 214 consecutive patients with STEMI and multivessel CAD undergoing primary angioplasty were studied. Before the first angioplasty patients were randomly assigned to three different strategies: culprit vessel angioplasty-only (COR group); staged revascularisation (SR group) and simultaneous treatment of non-IRA (CR group). Results During a mean follow-up of 2.5 years, 42 (50.0%) patients in the COR group experienced at least one major adverse cardiac event (MACE), 13 (20.0%) in the SR group and 15 (23.1%) in the CR group, p<0.001. Inhospital death, repeat revascularisation and rehospitalisation occurred more frequently in the COR group (all p<0.05), whereas there was no significant difference in re-infarction among the three groups. Survival free of MACE was significantly reduced in the COR group but was similar in the CR and SR groups. Conclusions Culprit vessel-only angioplasty was associated with the highest rate of long-term MACE compared with multivessel treatment. Patients scheduled for staged revascularisation experienced a similar rate of MACE to patients undergoing complete simultaneous treatment of non-IRA.Primary percutaneous coronary intervention (PCI) is currently the treatment of choice in patients with acute ST-segment elevation myocardial infarction (STEMI). Coronary artery disease (CAD) is a diffuse process and patients presenting with a coronary syndrome in 20e40% of cases have multiple significant coronary lesions, which confer a substantially increased risk of cardiovascular morbidity and mortality. Contemporary guidelines recommend dilating only the infarct-related artery (IRA) during the urgent procedure, leaving the other stenosed vessels untreated (culprit-only revascularisation) or to dilate during a second elective procedure (staged revascularisation). Simultaneous treatment of IRA and non-IRA is recommended only in patients with cardiogenic shock.4 5 However, these guidelines are based on the results of earlier studies. With advancing technology and newer antiplatelet drugs, outcomes have improved even in patients undergoing multivessel and higher-risk elective procedures. 6 Yet, few reports have described outcomes of multivessel compared with IRA-only revascularisation in patients undergoing urgent mechanical reperfusion for STEMI, 7 8 and none have distinguished simultaneous treatment of non-IRA from the staged approach. Therefore, the optimal management of patients with multivessel disease in this setting remains still unclear.The aim of this study was to compare long-term outcomes of three different strategies during primary PCI in patients with STEMI ...

Radial access in patients with ST-segment elevation acute coronary syndrome is associated with significant clinical benefits, in terms of both lower morbidity and cardiac mortality. Thus, it should become the recommended approach in these patients, provided adequate operator and center expertise is present. (Radial Versus Femoral Investigation in ST Elevation Acute Coronary Syndrome [RIFLE-STEACS]; NCT01420614).

Background-The

After pre-operative stratification, patients undergoing elective major vascular surgery remain at high risk of MI and death. Events occur mainly early after surgery. cTnI elevations are frequent and independently associated with increased risk. These findings suggest the need for a major re-evaluation of our approach to these patients.