***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background Complete revascularization after coronary artery bypass surgery is a logical goal and improves symptomatic outcome and survival . However , the impact of complete revascularization in patients with three-vessel coronary disease with varying severities of angina and left ventricular dysfunction has not been clearly defined . Methods and Results The study was performed as a retrospective analysis of 3,372 nonr and omized surgical patients from the Coronary Artery Surgery Study ( CASS ) Registry who had three-vessel coronary disease . Group 1 ( 894 patients ) had class I or II angina ( Canadian Cardiovascular Society criteria ) and group 2 ( 2,478 patients ) had class III or IV angina . In group 1 , adjusted cumulative 4-year survivals according to the number of vessels bypassed were 85 % ( one vessel ) , 94 % ( two vessels ) , 96 % ( three vessels ) , and 96 % ( more than three vessels ) ( log rank , p = 0.022 ) . Adjusted event-free survival ( death , myocardial infa rct ion , definite angina , or reoperation ) was not influenced by the number of vessels bypassed , nor was the anginal status among patients remaining alive after 5 years . In group 2 , adjusted cumulative 5-year survivals were 78 % ( one vessel ) , 85 % ( two vessels ) , 90 % ( three vessels ) , and 87 % ( more than three vessels ) ( log rank , p = 0.074 ) . Adjusted event-free survivals after 6 years were 23 % ( one vessel ) , 23 % ( two vessels ) , 29 % ( three vessels ) , and 31 % ( more than three vessels ) ( p = 0.025 ) ; at 5 years , those with more complete revascularization were more likely to be asymptomatic or free of severe angina . Among group 2 patients with ejection fractions < 0.35 , 6-year survival was 69 % for those with grafts to three or more vessels versus 45 % for those with grafts to two vessels ( p = 0.04 ) . Placing grafts to three or more vessels was independently associated with improved survival and event-free survival in group 2 but not group 1 patients . The case – fatality rates among 529 patients experiencing a myocardial infa rct ion during follow-up was significantly higher for patients with less complete revascularization . Conclusions Complete revascularization ( grafts to three or more vessels ) in patients with three-vessel coronary disease appears to most benefit those with severe angina and left ventricular dysfunction Background — The impact of incomplete revascularization ( IR ) on adverse outcomes after percutaneous coronary intervention remains inconclusive , and few studies have examined mortality during follow-ups longer than 5 years . The objective of this study is to test the hypothesis that IR is associated with higher risk of long-term ( 8-year ) mortality after stenting for multivessel coronary disease . Methods and Results — A total of 13 016 patients with multivessel disease who had undergone stenting procedures with bare metal stents in 1999 to 2000 were identified in the New York State 's Percutaneous Coronary Intervention Reporting System . A logistic regression model was fit to predict the probability of achieving complete revascularization ( CR ) in these patients using baseline risk factors ; then , the CR patients were matched to the IR patients with similar likelihoods of achieving CR . Each patient 's vital status was followed through 2007 using the National Death Index , and the difference in long-term mortality between IR and CR was compared . It was found that CR was achieved in 29.2 % ( 3803 ) of the patients . For the 3803 pair-matched patients , the respective 8-year survival rates were 80.8 % and 78.5 % for CR and IR ( P=0.04 ) , respectively . The risk of death was marginally significantly higher for IR ( hazard ratio=1.12 ; 95 % confidence interval , 1.01–1.26 , P=0.04 ) . The 95 % bootstrap confidence interval for the hazard ratio was 0.98 to 1.32 . Conclusions — IR may be associated with higher risk of long-term mortality after stenting with BMS in patients with multivessel disease . More prospect i ve studies are needed to further test this association BACKGROUND For the treatment of myocardial infa rct ion with ST-segment elevation , primary angioplasty is considered superior to fibrinolysis for patients who are admitted to hospitals with angioplasty facilities . Whether this benefit is maintained for patients who require transportation from a community hospital to a center where invasive treatment is available is uncertain . METHODS We r and omly assigned 1572 patients with acute myocardial infa rct ion to treatment with angioplasty or accelerated treatment with intravenous alteplase ; 1129 patients were enrolled at 24 referral hospitals and 443 patients at 5 invasive-treatment centers . The primary study end point was a composite of death , clinical evidence of reinfa rct ion , or disabling stroke at 30 days . RESULTS Among patients who underwent r and omization at referral hospitals , the primary end point was reached in 8.5 percent of the patients in the angioplasty group , as compared with 14.2 percent of those in the fibrinolysis group ( P=0.002 ) . The results were similar among patients who were enrolled at invasive-treatment centers : 6.7 percent of the patients in the angioplasty group reached the primary end point , as compared with 12.3 percent in the fibrinolysis group ( P=0.05 ) . Among all patients , the better outcome after angioplasty was driven primarily by a reduction in the rate of reinfa rct ion ( 1.6 percent in the angioplasty group vs. 6.3 percent in the fibrinolysis group , P<0.001 ) ; no significant differences were observed in the rate of death ( 6.6 percent vs. 7.8 percent , P=0.35 ) or the rate of stroke ( 1.1 percent vs. 2.0 percent , P=0.15 ) . Ninety-six percent of patients were transferred from referral hospitals to an invasive-treatment center within two hours . CONCLUSIONS A strategy for reperfusion involving the transfer of patients to an invasive-treatment center for primary angioplasty is superior to on-site fibrinolysis , provided that the transfer takes two hours or less Background Few reports described outcomes of complete compared with infa rct -related artery (IRA)-only revascularisation in patients with ST-elevation myocardial infa rct ion ( 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 r and omly 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 re-hospitalisation occurred more frequently in the COR group ( all p<0.05 ) , whereas there was no significant difference in re-infa rct ion 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 AIMS To examine the incidence of and propensity for non-culprit interventions performed at the time of the  primary percutaneous coronary intervention ( PCI )  and its association with 90-day outcomes . METHODS AND RESULTS We examined the incidence , propensity for , and associated 90-day outcomes following non-culprit interventions performed at the time of primary PCI among ST-elevation myocardial infa rct ion patients with multi-vessel coronary artery disease ( MVD ) . Of the 5373 patients who underwent primary PCI in the APEX-AMI trial , 2201 had MVD . Of those , 217 ( 9.9 % ) underwent non-infa rct -related arteries ( IRA ) PCI , whereas 1984 ( 90.1 % ) underwent PCI of the IRA alone . Ninety-day death and death/CHF/shock were higher in the non-IRA group compared with the IRA-only PCI group ( 12.5 vs. 5.6 % , P ( log-rank ) < 0.001 and 17.4 vs. 12.0 % , P ( log-rank ) = 0.020 , respectively ) . After adjusting for patient and procedural characteristics as well as propensity for performing non-IRA PCI , this procedure remained independently associated with an increased hazard of 90-day mortality [ adjusted hazard ratio 2.44 , 95 % CI ( 1.55 - 3.83 ) , P < 0.001 ] . CONCLUSION Non-culprit coronary interventions were performed at the time of primary PCI in 10 % of MVD patients and were significantly associated with increased mortality . Our data support current guideline recommendations discouraging the performance of such procedures in stable primary PCI patients . Prospect i ve r and omized study of this issue may be warranted BACKGROUND Rapid recanalization of infa rct -related artery ( IRA ) has become the major target during primary percutaneous coronary intervention ( PCI ) for patients with ST-elevation myocardial infa rct ion ( MI ) , but strategy for treatment of non-IRA lesions in this setting remains unclear . This study aim ed to compare long-term effects between PCI for IRA only and that for both IRA and non-IRA in ST-elevation MI patients with multi-vessel disease . METHODS A total of 242 eligible patients with ST-elevation MI and at least two diseased coronary arteries ( luminal narrowing > or = 70 % ) undergoing primary PCI were included . Of them , 149 patients underwent primary PCI for IRA only  ( group 1 ) , and 93 received primary PCI for IRA followed by elective PCI for non-IRA 7 to 15 days after acute myocardial infa rct ion ( AMI ) ( group 2 ) . Drug-eluting stents ( DESs ) were deployed in more than 90 % of the patients . RESULTS The two groups did not differ with respect to baseline clinical and angiographic characteristics . No significant differences were observed in 12-month clinical follow-up results regarding major adverse cardiac events ( 11.5 % vs 15.1 % , P > 0.05 ) and target lesion revascularization ( 8.1 % vs 7.6 % , P > 0.05 ) between the two groups . However , patients in group 1 had higher rates of recurrent angina ( 10.1 % vs 2.1 % , P < 0.05 ) and depressed left ventricular ejection fraction evaluated by echocardiography ( 0.56 + /- 0.22 vs 0.63 + /- 0.25 , P < 0.05 ) . CONCLUSION With the use of DESs , complete revascularization with elective PCI for non-IRA after primary PCI may exert a beneficial effect on long-term symptomatology and left ventricular function in patients with ST-elevation MI and multi-vessel disease BACKGROUND The success of thrombolytic therapy for acute myocardial infa rct ion is limited by bleeding complications , the impossibility of reperfusing all occluded coronary arteries , recurrent myocardial ischemia , and the relatively small number of patients who are appropriate c and i date s for this therapy . We hypothesized that these problems could be overcome by the use of immediate percutaneous transluminal coronary angioplasty ( PTCA ) , without previous thrombolytic therapy . METHODS At 12 clinical centers , 395 patients who presented within 12 hours of the onset of myocardial infa rct ion were treated with intravenous heparin and aspirin and then r and omly assigned to undergo immediate PTCA ( without previous thrombolytic therapy , 195 patients ) or to receive intravenous tissue plasminogen activator ( t-PA , 200 patients ) followed by conservative care . Radionuclide ventriculography was performed to assess ventricular function within 24 hours and at six weeks . RESULTS Among the patients r and omly assigned to PTCA , 90 percent underwent the procedure ; the success rate was 97 percent , and no patient required emergency coronary-artery bypass surgery . The in-hospital mortality rates in the t-PA and PTCA groups were 6.5 and 2.6 percent , respectively ( P = 0.06 ) . In a post hoc analysis , the mortality rates in the subgroups classified as " not low risk " were 10.4 and 2.0 percent , respectively ( P = 0.01 ) . Reinfa rct ion or death in the hospital occurred in  
    Output:
    
Overall , staged multivessel PCI  improved short- and long-term survival and reduced repeat PCI .