***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 
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    Input: Aim We assessed the management and outcomes of non-ST segment elevation myocardial infa rct ion ( NSTEMI ) patients r and omly assigned to fractional flow reserve (FFR)-guided management or angiography-guided st and ard care . Methods and results We conducted a prospect i ve , multicentre , parallel group , 1 : 1 r and omized , controlled trial in 350 NSTEMI patients with ≥1 coronary stenosis ≥30 % of the lumen diameter assessed visually ( threshold for FFR measurement ) ( NCT01764334 ) . Enrolment took place in six UK hospitals from October 2011 to May 2013 .  Fractional flow reserve was disclosed to the operator in the FFR-guided group ( n = 176 ) . Fractional flow reserve was measured but not disclosed in the angiography-guided group ( n = 174 ) . Fractional flow reserve ≤0.80 was an indication for revascularization by percutaneous coronary intervention ( PCI ) or coronary artery bypass surgery ( CABG ) . The median ( IQR ) time from the index episode of myocardial ischaemia to angiography was 3 ( 2 , 5 ) days . For the primary outcome , the proportion of patients treated initially by medical therapy was higher in the FFR-guided group than in the angiography-guided group [ 40 ( 22.7 % ) vs. 23 ( 13.2 % ) , difference 95 % ( 95 % CI : 1.4 % , 17.7 % ) , P = 0.022 ] . Fractional flow reserve disclosure result ed in a change in treatment between medical therapy , PCI or CABG in 38 ( 21.6 % ) patients . At 12 months , revascularization remained lower in the FFR-guided group [ 79.0 vs. 86.8 % , difference 7.8 % ( −0.2 % , 15.8 % ) , P = 0.054 ] . There were no statistically significant differences in health outcomes and quality of life between the groups . Conclusion In NSTEMI patients , angiography-guided management was associated with higher rates of coronary revascularization compared with FFR-guided management . A larger trial is necessary to assess health outcomes and cost-effectiveness 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 OBJECTIVES The purpose of this study was to investigate the 2-year outcome of percutaneous coronary intervention ( PCI ) guided by fractional flow reserve ( FFR ) in patients with multivessel coronary artery disease ( CAD ) . BACKGROUND In patients with multivessel CAD undergoing PCI , coronary angiography is the st and ard method for guiding stent placement . The FAME ( Fractional Flow Reserve Versus Angiography for Multivessel Evaluation ) study showed that routine FFR in addition to angiography improves outcomes of PCI at 1 year . It is unknown if these favorable results are maintained at 2 years of follow-up . METHODS At 20 U.S. and European medical centers , 1,005 patients with multivessel CAD were r and omly assigned to PCI with drug-eluting stents guided by angiography alone or guided by FFR measurements . Before r and omization , lesions requiring PCI were identified based on their angiographic appearance . Patients r and omized to angiography-guided PCI underwent stenting of all indicated lesions , whereas those r and omized to FFR-guided PCI underwent stenting of indicated lesions only if the FFR was < or=0.80 . RESULTS The number of indicated lesions was 2.7+/-0.9 in the angiography-guided group and 2.8+/-1.0 in the FFR-guided group ( p=0.34 ) . The number of stents used was 2.7+/-1.2 and 1.9+/-1.3 , respectively ( p<0.001 ) . The 2-year rates of mortality or myocardial infa rct ion were 12.9 % in the angiography-guided group and 8.4 % in the FFR-guided group ( p=0.02 ) . Rates of PCI or coronary artery bypass surgery were 12.7 % and 10.6 % , respectively ( p=0.30 ) . Combined rates of death , nonfatal myocardial infa rct ion , and revascularization were 22.4 % and 17.9 % , respectively ( p=0.08 ) . For lesions deferred on the basis of FFR>0.80 , the rate of myocardial infa rct ion was 0.2 % and the rate of revascularization was 3.2 % after 2 years . CONCLUSIONS Routine measurement of FFR in patients with multivessel CAD undergoing PCI with drug-eluting stents significantly reduces mortality and myocardial infa rct ion at 2 years when compared with st and ard angiography-guided PCI . ( Fractional Flow Reserve Versus Angiography for Multivessel Evaluation [ FAME ] ; NCT00267774 ) Background — Magnetic resonance myocardial perfusion imaging ( MRMPI ) has a number of advantages over the other noninvasive tests used to detect reversible myocardial ischemia . The majority of previous studies have generally used quantitative coronary angiography as the gold st and ard to assess the accuracy of MRMPI ; however , only an approximate relationship exists between stenosis severity and functional significance . Pressure wire – derived fractional flow reserve ( FFR ) values < 0.75 correlate closely with objective evidence of reversible ischemia . Accordingly , we have compared MRMPI with FFR . Methods and Results — One hundred three patients referred for investigation of suspected angina underwent MRMPI with a 1.5-T scanner . The stress agent was intravenous adenosine ( 140 & mgr;g · kg−1 · min−1 ) , and the first-pass bolus contained 0.1 mmol/kg gadolinium . In the following week , coronary angiography with pressure wire studies was performed . FFR was recorded in all patent major epicardial coronary arteries , with a value < 0.75 denoting significant stenosis . MRMPI scans , analyzed by 2 blinded observers , identified perfusion defects in 121 of 300 coronary artery segments ( 40 % ) , of which 110 had an FFR < 0.75 . We also found that 168 of 179 normally perfused segments had an FFR ≥0.75 . The sensitivity and specificity of MRMPI for the detection of functionally significant coronary heart disease were 91 % and 94 % , respectively , with positive and negative predictive values of 91 % and 94 % . Conclusion — MRMPI can detect functionally significant coronary heart disease with excellent sensitivity , specificity , and positive and negative predictive values compared with FFR 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 Non-infa rct -related artery ( non-IRA ) disease is prevalent in patients with ST-segment elevation myocardial infa rct ion ( STEMI ) . We aim ed to assess the impact of non-IRA disease on infa rct size and clinical outcomes in patients with acute STEMI . METHODS The Counterpulsation to Reduce Infa rct Size Pre-PCI Acute Myocardial Infa rct ion ( CRISP-AMI ) trial r and omized patients to intra-aortic balloon counterpulsation ( IABC ) vs no IABC prior to percutaneous coronary intervention in patients with acute STEMI . Infa rct size ( % left ventricular mass ) at 3 - 5 days post percutaneous coronary intervention and 6-month clinical outcomes were compared between patients with and without non-IRA disease ( defined as ≥50 % stenosis in at least one non-IRA ) . RESULTS A total of 324 ( 96.1 % ) patients had anterior STEMI , of whom 34.9 % had non-IRA disease . There was no difference in infa rct size ( % left ventricular mass ) between patients with and without non-IRA disease ( median 39 % vs 39 % ; P = .73 ) . At 6 months , there was no difference in rates of recurrent myocardial infa rct ion ( 0.9 % vs 0.9 % ; P = .78 ) , major Thrombol 
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Conclusions In patients with STEMI and MVD , FFR-guided CR is better than COR in terms of MACE and ischemia-driven repeat revascularization , while there are almost similar in all-cause mortality .