***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: OBJECTIVES To test our hypothesis that the development of vulnerable plaques is not limited to the culprit lesions , but is a pan-coronary process , we directly observed all three major coronary arteries by angioscopy and evaluated the prevalence of yellow plaques in patients with myocardial infa rct ion ( MI ) . BACKGROUND Although pathologic studies have suggested that the disruption of atheromatous plaque plays a major role in the development of acute MI , the prevalence of yellow plaques in the whole coronary arteries of patients with MI has not been clarified . METHODS Thirty-two patients undergoing follow-up catheterization one month after the onset of MI were prospect ively and consecutively enrolled in this study . The prevalence of yellow plaques and thrombus in the major coronary arteries was successfully evaluated in 20 patients ( 58 coronary arteries , 21 culprit lesions ) by coronary angioscopy .  The diameter stenosis ( DS ) of the culprit lesions and the maximal diameter stenosis ( maxDS ) of nonculprit segments were angiographically measured for each coronary artery . RESULTS The DS of the culprit lesions and maxDS were 27 + /- 17 % and 19 + /- 13 % , respectively . Yellow plaques and thrombus were detected in 19 ( 90 % ) and 17 ( 81 % ) of 21 culprit lesions , respectively . Yellow plaques were equally prevalent in the infa rct -related and non-infa rct -related coronary arteries ( 3.7 + /- 1.6 vs. 3.4 + /- 1.8 plaques/artery ) . However , thrombus was only detected in the nonculprit segments of one ( 2 % ) coronary artery . CONCLUSIONS In patients with MI , all three major coronary arteries are widely diseased and have multiple yellow though nondisrupted plaques . Acute MI may represent the pan-coronary process of vulnerable plaque development 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 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 OBJECTIVES This study was design ed to assess the prevalence and clinical significance of exaggerated nonculprit lesion stenosis in the setting of acute ( < 12 h ) myocardial infa rct ion ( AMI ) . BACKGROUND Although microvascular spasm may reduce nonculprit artery flow during AMI , it is unknown whether increased tone may exaggerate nonculprit lesion severity . METHODS In patients with additional angiography within nine months of AMI , and significant nonculprit lesions imaged in matching views , stenosis severity was compared between studies in a r and om blinded fashion using vali date d quantitative coronary angiography software . Baseline demographics , medications , hemodynamics at each study , and clinical status at follow-up ( infa rct /unstable angina/stable angina ) were used to determine the independent influence of the infa rct presentation on stenosis exaggeration . RESULTS From 548 patients with AMI ( 1/99 to 6/01 , 321 with multivessel disease ) , 112 had additional angiography ; of these 48 had 59 lesions suitable for analysis . Between infa rct and noninfa rct angiograms there was a significant change in minimal lumen diameter ( 1.53 + /- 0.51 mm vs. 1.78 + /- 0.65 mm , p < 0.001 ) and percentage stenosis ( 49.3 + /- 14.5 % vs. 40.4 + /- 16.6 % , p < 0.0001 ) of the nonculprit lesion without significant change in reference segment diameter , which was not predicted by changes in medication or hemodynamics . Twenty-one percent of patients had lesions > 50 % at AMI that were < 50 % at non-AMI angiography . Infa rct versus noninfa rct setting was the only significant independent predictor of change in nonculprit stenosis . CONCLUSIONS Significant exaggeration of nonculprit lesion stenosis severity occurs at infa rct angiography , which may affect revascularization decision making in an appreciable number of patients 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 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 
    Output:
    
Conclusions MV-PCI during the index of primary PCI in STEMI patients is associated with a higher mortality rate , a higher risk of bleeding complications , but lower risk of re-intervention and re-infa rct ion and comparable rates of MACE