["Unsuitable for PCI..." Multivessel primary PCI. But for whom?].

Following the recent publication of the PRAMI trial, the appearance of the article entitled ‘‘Multivessel approach in ST-elevation myocardial infarction: Impact on in-hospital morbidity and mortality’’ by Santos et al. in this issue of the Journal could not be more timely. The study analyzed a population of patients with ST-elevation myocardial infarction (STEMI) included in the Portuguese Registry of Acute Coronary Syndromes who underwent primary percutaneous coronary angioplasty (PCI), comparing patients treated by PCI of the culprit vessel only (n=180) with those who underwent PCI of vessels other than the infarct-related artery (n=77). Patients undergoing multivessel PCI were more often medicated with glycoprotein IIb/IIIa inhibitors (73.7% vs. 38.8%) and had more stents implanted (1.4 vs. 1.1 stents per lesion), more of which were drug-eluting stents (73.7% vs. 40.8%). In-hospital mortality and the incidence of complications (defined as major bleeding, need for transfusion, invasive ventilation, heart failure and reinfarction) were lower in the multivessel PCI group (2.6% vs. 7.8% and 23.4% vs. 32.8%, respectively). None of these differences reached statistical significance, probably due to the small sample size. Multivariate analysis identified