***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 Recent r and omized trials and meta-analyses demonstrated that a complete revascularization of significant non culprit lesions in patients with ST elevation myocardial infa rct ion ( STEMI ) is superior to a culprit only revascularization approach in reducing major adverse cardiac events ( MACE ) , however the proportion of diabetic patients was low in these trials . OBJECTIVES To investigate whether a complete revascularization approach is associated with better outcomes in diabetic patients with STEMI and multi-vessel disease . METHODS One hundred diabetic patients with acute STEMI with at least one non-culprit lesion were r and omized to either complete revascularization ( n = 50 ) or culprit-only treatment ( n = 50 ) . Complete revascularization was performed either at the time of primary percutaneous coronary intervention ( PCI ) or within 72 hours during hospitalization . The primary endpoint was the composite of all-cause mortality , recurrent MI , and ischemia-driven revascularization at 6 months . RESULTS A complete revascularization approach was significantly associated with a reduction in the primary outcome ( 6 % vs. 24 % , P = 0.01 ) , primarily due to reduction in ischemia driven revascularization in the complete revascularization group ( 2 % vs. 12 % ; P = 0.047 ) . There was no significant reduction in death or MI ( 2 % vs. 8 % ; P = 0.17 ) and ( 2 % vs. 4 % ; P = 0.56 ) respectively , or in the safety endpoints of major or minor bleeding , contrast-induced nephropathy , or stroke between the groups . CONCLUSIONS In diabetic patients with multi-vessel coronary artery disease undergoing PPCI , complete revascularization is associated with significantly reduced risk of adverse cardiovascular events , as compared with culprit vessel only PCI . ( J Interven Cardiol 2016;29:241 - 247 ) Background There are conflicting data regarding optimal treatment of non-culprit lesions detected during primary percutaneous coronary intervention ( PCI ) in patients with ST-elevation myocardial infa rct ion ( STEMI ) and multi-vessel disease ( MVD ) . We aim ed to investigate whether ischaemia-driven early invasive treatment improves the long-term outcome and prevents major adverse cardiac events ( MACE ) . Methods 121 patients with at least one non-culprit lesion were r and omised in a 2:1 manner , 80 were r and omised to early fractional flow reserve (FFR)-guided PCI  ( invasive group ) , and 41 to  medical treatment  ( conservative group ) . The primary endpoint was MACE at 3 years . Results Three-year follow-up was available in 119 patients ( 98.3 % ) . There was no significant difference in all-cause mortality between the invasive and conservative strategy , 4 patients ( 3.4 % ) died , all in the invasive group ( P = 0.29 ) . Re-infa rct ion occurred in 14 patients ( 11.8 % ) in the invasive group versus none in the conservative group ( p = 0.002 ) . Re-PCI was performed in 7 patients ( 8.9 % ) in the invasive group and in 13 patients ( 32.5 % ) in the conservative group ( P = 0.001 ) . There was no difference in MACE between these two strategies ( 35.4 vs 35.0 % , p = 0.96 ) . Conclusions In STEMI patients with MVD , early FFR-guided additional revascularisation of the non-culprit lesion did not reduce MACE at three-year follow-up compared with a more conservative strategy . The rate of MACE in the invasive group was predominantly driven by death and re-infa rct ion , whereas in the conservative group the rate of MACE was only driven by repeat interventions Results of recent studies have suggested that routine cardiac catheterization may be unnecessary after reperfusion therapy for acute myocardial infa rct ion . Therefore to better define the short-term prognostic value of early coronary angiography , and specifically the prognostic significance of multivessel coronary artery disease , the angiographic findings of 855 patients consecutively enrolled in five phases of the TAMI study were correlated with their in-hospital outcome . All patients received intravenous thrombolytic therapy ( tissue plasminogen activator , urokinase , or both agents ) and underwent cardiac catheterization within 90 minutes of the initiation of therapy . Multivessel disease , defined as the presence of greater than or equal to 75 % luminal diameter stenosis in two or more major epicardial arteries , was documented in 236 patients . When compared with the group of patients without multivessel disease , this group had a higher prevalence of coronary risk factors and more frequently had a history of antecedent ischemic chest pain . Although the severity of the infa rct zone dysfunction was similar in the two groups ( -2.77 + /- 1.00 vs -2.50 + /- 1.09 SD/chord , p = NS ) , global left ventricular ejection fraction was lower in the group with multivessel disease ( 48.6 + /- 12.4 % vs 51.8 + /- 10.6 % , p less than 0.01 ) . This was associated with a significant difference in the function of the noninfa rct zone . Whereas this region was hyperkinetic in the group with minimal or single-vessel disease , it was hypocontractile or dyskinetic in those with multivessel disease ( + 0.66 + /- 1.53 vs -0.52 + /- 1.73 SD/chord , p = 0.0001 ) . ( ABSTRACT TRUNCATED AT 250 WORDS Background : In the Preventive Angioplasty in Myocardial Infa rct ion trial ( PRAMI ; IS RCT N73028481 ) , immediate multivessel PCI ( MV-PCI ) of non-IRA ( infa rct related artery ) lesions in patients with acute ST elevation myocardial infa rct ion ( STEMI ) and multivessel coronary disease ( MVD ) improved long term prognosis . We assessed infa rct distribution and size in a pre-specified cardiac magnetic resonance ( CMR ) sub- study . Methods : In this single centre prospect i ve sub- study , PRAMI participants were invited to undergo 1.5 Tesla CMR 1 week and 1 year after primary PCI . The CMR scans were analysed using semi-automated software by a clinician blinded to treatment group assignment and clinical outcomes . The presence and extent of infa rct ion were assessed quantitatively with late gadolinium enhancement ( LGE ) imaging ( Gadovist , 0.1 mmol/kg ) . The infa rct was delineated as an area of myocardial enhancement ( cm2 ) using a signal intensity threshold of > 5SDs above a remote region , and expressed as a % of total LV mass . The incidence of new LGE in non-infa rct related artery territories at baseline and 1 year were assessed . Data were analysed by an independent statistician . Results : Of 465 r and omised trial participants in 6 UK hospitals , 138 ( 30 % ) were enrolled in Glasgow . Of these 80 patients underwent CMR 1 week post primary PCI of whom 41 ( 51 % ) were in the multi-vessel PCI group and 39 ( 49 % ) were in the IRA-only group . At 1 year , 69 ( 86 % ) patients had a follow up CMR scan . Infa rct size and distribution are described in Table 1 BACKGROUND In patients undergoing primary percutaneous coronary intervention for ST-segment elevation myocardial infa rct ion , ischemic postconditioning has been shown to reduce infa rct size , but the effect on clinical outcome has not been tested in a large r and omized trial . In addition , deferring stent implantation in the infa rct -related lesion 1 to 3 days after acute opening of the infa rct -related artery could have protective effects , by reducing the risk of injury caused by distal embolization and microvascular obstruction . Finally , a considerable fraction of patients present with lesions in other coronary artery branches than the infa rct -related artery . Whether a strategy of complete or partial revascularization of these patients should be preferred remains uncertain . STUDY DESIGN The DANAMI 3 trial program was design ed to investigate 3 different r and omized treatment strategies in patients with ST-segment elevation myocardial infa rct ion : ( 1 ) ischemic postconditioning versus conventional treatment with a primary end point of death and hospitalization for heart failure ; ( 2 ) deferring stent implantation in the infa rct -related lesion versus conventional treatment with a primary end point of death , hospitalization for heart failure , reinfa rct ion , and repeat revascularization  ; and ( 3 ) treatment of the culprit lesion only versus fractional flow reserve-guided complete revascularization in patients with multivessel disease , with a primary end point of death , reinfa rct ion , and repeat revascularization . SUMMARY The DANAMI 3 trial program will determine whether either of 2 approaches to reduce reperfusion injury and distal microvascular obstruction with postconditioning or deferred stent implantation will translate into improved clinical outcome and whether patients with multivessel disease undergoing primary percutaneous coronary intervention will benefit from a strategy of complete or partial revascularization 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 
    Output:
    
TSA of long-term all-cause mortality , long-term cardiovascular mortality , and long-term non-fatal myocardial infa rct ion showed that more RCTs are needed to reach more conclusive results on these outcomes .
Regarding long-term repeat revascularisation more RCTs may not change our present result .
TSA also supports the need for more RCTs in order to draw stronger conclusions regarding the effects of complete revascularisation on long-term all-cause mortality , long-term cardiovascular mortality , and long-term non-fatal myocardial infa rct ion