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[Angioplasty on all lesions in case of myocardial infarction? Not for the time being].

Treatment for acute myocardial infarction currently entails immediate percutaneous revascularization of the culprit artery. Around 50% of the patients with an acute myocardial infarction have additional multivessel coronary artery disease. Patients with multivessel disease are known to have a worse prognosis compared to patients with single vessel disease. Also, immediate additional revascularization in the acute phase has not been associated with improved outcome but with more complications. In the current practice guidelines, additional revascularization is contra-indicated in the acute phase and only warranted in case of persistent symptoms or ischaemia after the acute event. Elective PCI resolves symptoms but its impact on prognosis is less evident. The outcome of the PRAMI trial claims that percutaneous coronary intervention (PCI) of all > 50% lesions improves prognosis. This seems unrealistic. We believe that the study design with a composite endpoint that incorporates the normal treatment strategy ensures a positive outcome but without clinical significance.