Complete revascularisation in STEMI with multivessel disease should be

performed in the middle of the night :

The case AGAINST

Nick West Papworth HospitalCambridge, UK

NO  CONFLICTS  TO  DECLARE

Even John McEnroe agrees it’s daft

So why is it such a bad idea?

• Level of evidence

• RCTs vs registries?

• Cath lab team wear and tear

• Impact on working day

• Pragmatic factors

Eminent Cardiologist Tired Tony thinks:

How can I stay in bed?

Eminent Cardiologist Tired Tony thinks:

How can I stay in bed?

OK that didn’t work out…

How about letting the paramedics do

the work?

Maybe if we just lyse them again –

or even do nothing?

One last go…I’m sure we can get

away with just doing the culprit...

CvLPRIT PRAMI

Where the madness started…

CvLPRIT: 1 in 3 includedPRAMI: 1 in 5 included

(…and btw nearly 50% had 1 VD only)

Interventional pragmatism

Interventional pragmatism #2

Interventional pragmatism #3

Seduced by CLeOPatR(a)??

‘Our courteous Antony, whom ne’er the word of ‘No’ woman heard speak…’William Shakespeare

So why is it such a bad idea?

• Level of evidence

• RCTs vs registries?

• Cath lab team wear and tear

• Impact on working day

• Pragmatic factors

Tired Tony says:

“Leave it to the physicians;Physicians are very good at making decisions”