***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: AIMS Stenting an angiographically intermediate but functionally non-significant stenosis is controversial . Nevertheless , it has been question ed if deferral of a functionally non-significant lesion on the basis of fractional flow reserve ( FFR ) measurement , is safe , especially on the long term . Five-year follow-up of the DEFER trial showed that outcome after deferral of percutaneous coronary intervention ( PCI ) of an intermediate coronary stenosis based on FFR ≥ 0.75 is excellent and was not improved by stenting . The aim of this study was to investigate the validity of this position on the very long term . METHODS AND RESULTS In 325 patients scheduled for PCI of an intermediate stenosis  , FFR was measured just before the planned intervention . If FFR was ≥0.75 , patients were r and omly assigned to deferral ( Defer group ; n = 91 ) or performance ( Perform group ; n = 90 ) of PCI . If FFR was < 0.75 , PCI was performed as planned ( Reference group ; n = 144 ) . Clinical follow-up was 15 years . There were no differences in baseline clinical characteristics between the r and omized groups . Complete 15-year follow-up was obtained in 92 % of patients . After 15 years of follow-up , the rate of death was not different between the three groups : 33.0 % in the Defer group , 31.1 % in the Perform group , and 36.1 % in the Reference group ( Defer vs. Perform , RR 1.06 , 95 % CI : 0.69 - 1.62 , P = 0.79 ) . The rate of myocardial infa rct ion was significantly lower in the Defer group ( 2.2 % ) compared with the Perform group ( 10.0 % ) , RR 0.22 , 95 % CI : 0.05 - 0.99 , P = 0.03 . CONCLUSION Deferral of PCI of a functionally non-significant stenosis is associated with a favourable very long-term follow-up without signs of late ' catch-up ' phenomenon 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 Background Coronary revascularization guided by fractional flow reserve ( FFR ) is associated with better patient outcomes after the procedure than revascularization guided by angiography alone . It is unknown whether the instantaneous wave‐free ratio ( iFR ) , an alternative measure that does not require the administration of adenosine , will offer benefits similar to those of FFR . Methods We r and omly assigned 2492 patients with coronary artery disease , in a 1:1 ratio , to undergo either iFR‐guided or FFR‐guided coronary revascularization . The primary end point was the 1‐year risk of major adverse cardiac events , which were a composite of death from any cause , nonfatal myocardial infa rct ion , or unplanned revascularization . The trial was design ed to show the noninferiority of iFR to FFR , with a margin of 3.4 percentage points for the difference in risk . Results At 1 year , the primary end point had occurred in 78 of 1148 patients ( 6.8 % ) in the iFR group and in 83 of 1182 patients ( 7.0 % ) in the FFR group ( difference in risk , ‐0.2 percentage points ; 95 % confidence interval [ CI ] , ‐2.3 to 1.8 ; P<0.001 for noninferiority ; hazard ratio , 0.95 ; 95 % CI , 0.68 to 1.33 ; P=0.78 ) . The risk of each component of the primary end point and of death from cardiovascular or noncardiovascular causes did not differ significantly between the groups . The number of patients who had adverse procedural symptoms and clinical signs was significantly lower in the iFR group than in the FFR group ( 39 patients [ 3.1 % ] vs. 385 patients [ 30.8 % ] , P<0.001 ) , and the median procedural time was significantly shorter ( 40.5 minutes vs. 45.0 minutes , P=0.001 ) . Conclusions Coronary revascularization guided by iFR was noninferior to revascularization guided by FFR with respect to the risk of major adverse cardiac events at 1 year . The rate of adverse procedural signs and symptoms was lower and the procedural time was shorter with iFR than with FFR . ( Funded by Philips Volcano ; DEFINE‐FLAIR Clinical Trials.gov number , NCT02053038 . 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 In patients with ST‐segment elevation myocardial infa rct ion ( STEMI ) , the use of percutaneous coronary intervention ( PCI ) to restore blood flow in an infa rct ‐related coronary artery improves outcomes . The use of PCI in non‐infa rct ‐related coronary arteries remains controversial . METHODS We r and omly assigned 885 patients with STEMI and multivessel disease who had undergone primary PCI of an infa rct ‐related coronary artery in a 1:2 ratio to undergo complete revascularization of non‐infa rct ‐related coronary arteries guided by fractional flow reserve ( FFR ) ( 295 patients ) or to undergo no revascularization of non‐infa rct ‐related coronary arteries ( 590 patients ) . The FFR procedure was performed in both groups , but in the latter group , both the patients and their cardiologist were unaware of the findings on FFR . The primary end point was a composite of death from any cause , nonfatal myocardial infa rct ion , revascularization , and cerebrovascular events at 12 months . Clinical ly indicated elective revascularizations performed within 45 days after primary PCI were not counted as events in the group receiving PCI for an infa rct ‐related coronary artery only . RESULTS The primary outcome occurred in 23 patients in the complete‐revascularization group and in 121 patients in the infa rct ‐artery‐only group that did not receive complete revascularization , a finding that translates to 8 and 21 events per 100 patients , respectively ( hazard ratio , 0.3 
    Output:
    
Overall , performing complete revascularization in STEMI patients showed a MACE reduction , all-cause death and repeat revascularization .
Compared to culprit-only revascularization , treating multi-vessel disease in STEMI patients using FFR guidance is associated with decreased incidence of MACE , due to a decreased rate of revascularization