Based on this meta-analysis of primarily observational data, complete revascularization (CR) is associated with a reduced risk of death, MI, and repeat revascularization in patients with multivessel coronary artery disease (MVCAD) as compared with incomplete revascularization (IR). Given the current state of evidence, the likelihood of achieving complete revascularization should influence whether PCI or CABG is the best strategy in patients with MVCAD. Given the lack of randomized trials in this area, more robust trial data will address the validity of these findings.

Urgent and timely revascularization is a wellestablished cornerstone of therapy in the treatment of ST elevation myocardial infarction (STEMI). However, guidelines directing therapy in non-ST segment elevation myocardial infarction (NSTEMI) are not as definitive. These guidelines recommend two treatment pathways: an early invasive strategy (EIS) and an initial conservative strategy.The EIS directs patients toward invasive diagnostic evaluation often prior to noninvasive testing, without failing medical therapy, and on a more expeditious time frame (<24 h from presentation). This strategy confers several advantages besides risk stratification alone. Percutaneous intervention of the culprit lesion reduces the need for chronic anti-anginal therapy and rehospitalizations. In addition, patients identified as having multivessel disease would gain the added mortality benefit from referral for coronary artery bypass graft surgery early.The initial conservative strategy recommends an invasive approach for those who fail medical therapy or if there is objective evidence of active ischemia on noninvasive testing. This strategy has the advantage of avoiding the risks associated with an invasive procedure. When this strategy is chosen, often noninvasive evaluation is required to assess for significant ischemia and to identify left ventricular dysfunction. Deciding which strategy to take can be done based on riskstratifying patients using risk calculators such as thrombolysis in myocardial infarction (MI) or the global registry of acute coronary events calculator [1].In the United States, among people who died of ischemic heart disease, 83% were older than 65 years. Moreover, even though people older than 75 years only account for 6% of the US population, they represent 60% of MI-related deaths [2]. Increasing age is one of the major predictors of poorer outcomes in NSTEMI. However, despite the fact that the guidelines recommend therapeutic interventions based on risk rather than age, there appears to be widespread reluctance to use an invasive strategy in a uniform manner in the elderly population. This is likely in part, due to the fact that the elderly population is under-represented or excluded in acute coronary syndrome (ACS) clinical trials; therefore, there is limited evidence guiding treatment in this population.In this issue of Catheterization and Cardiovascular Interventions, Angeli et al.[3] present a meta-analysis of nine randomized clinical trials (RCTs) involving 9,400 patients comparing the benefit of an EIS to a selectively invasive strategy (SIS). The primary composite endpoint of MI and all-cause death was 16% in the EIS group and 18.3% in the SIS group (OR: 0.85, 95% CI: 0.76-0.95). In addition, the reduction in rehospitalization and recurrent MI was greater in the older population (>65 years) as compared to younger study populations. Moreover, the benefit was seen in both male and female subgroups.This article adds to the evidence suggesting the benefits of EIS that has been accumulating since 1999. Evidenc...

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This study demonstrates that in a single center, single operator experience, ulnar artery catheterization is feasible, though even compared to radial access, a significant learning curve remains. Although ulnar access is a reasonable alternative approach to catheterization, the true benefits of ulnar access, compared to radial are unclear. Further large randomized multicenter, multi-operator trials are needed to assess the true feasibility and benefit of ulnar artery catheterization.

Key Points This article describes a single‐center experience of Everolimus‐eluting bioresorbable scaffolds as an alternative to drug eluting stents in diabetic patients with various presentations of coronary artery disease. The results suggest the possibility of a paradigm shift for treatment in this population as ultimately no metallic remains are left to act as a nidus for inflammation. The study suggests the benefits as well as technical limitations of the current bioresorbable scaffold (BRS) technology, such as increased strut thickness, decreased deliverability, and increase in major cardiovascular events compared to current drug eluting stent (DES) technology.