Culprit vessel versus multivessel intervention and other stories . . .

We might look oddly at a plumber who came to clear a pipe and left saying “By the way, I saw several other bits that look a bit blocked but decided to leave them alone.” The blocked pipes model of coronary artery disease is widely shared by patients and clinicians, but it is delusive. When performing percutaneous stenting at the time of ST elevation myocardial infarction, many cardiologists are tempted to treat “bystander” coronary artery lesions as well as the culprit lesion. But in an observational study of outcomes in eight leading London tertiary centres (Circulation 2014, doi:10.1161/CIRCOUTCOMES.114.001194), this was strongly associated with greater in-hospital cardiac morbidity and higher mortality at one year.

And plumbers often fail to agree on what is a blocked pipe. Five coronary angiograms were sent on a web based platform to 495 interventional cardiologists so that they could decide on which lesions needed treatment (Circulation 2014, doi:10.1161/CIRCINTERVENTIONS.114.001608). They …