In the CvLPRIT (Complete Versus Culprit-Lesion Only Primary PCI) trial,18 296 patients were randomized to culprit artery only or multivessel PCI during the index hospitaliza- tion (72% underwent multivessel primary PCI). The compos- ite primary outcome of death, reinfarction, heart failure, and ischemia-driven revascularization at 12 months occurred in 15 patients (10%) who underwent multivessel PCI, compared with 31 patients (21%) receiving culprit artery only PCI (HR: PRIMULTI (Third Danish Study of Optimal Acute Treatment of Patients with ST-segment Elevation Myocardial Infarction) the composite primary outcome of all-cause death, nonfatal MI, or ischemia-driven revascularization of non- culprit artery disease occurred in 40 of 314 patients (13%) who underwent multivessel staged PCI guided by angiogra- phy and fractional flow reserve before discharge, versus 68 of 313 patients (22%) treated with culprit artery only PCI (HR: (Primary Angioplasty in Patients Transferred From General Community Hospitals to Specialized PTCA Units With or Without Emergency Thrombolysis) trial,27 214 patients with Table 1. Applying Class of Recommendation and Level of Evidence to Clinical Strategies, Interventions, Treatments, or Diagnostic Testing in Patient Care* (Updated August 2015) Levine et al 2015 ACC/AHA/SCAI Focused Update on Primary PCI 1139 STEMI were randomized to staged (3 to 40 days after the index procedure) revascularization of all 70% diameter stenosis noninfarct lesions or culprit-only PCI. Preliminary results at 38 months mean follow-up showed no between-group differ- ences in the composite primary endpoint of all-cause death, nonfatal MI, and stroke. On the basis of these findings,17,18,24,27 the prior Class III (Harm) recommendation with regard to multivessel primary PCI in hemodynamically stable patients with STEMI has been upgraded and modified to a Class IIb recommendation to include consideration of multivessel PCI, either at the time of primary PCI or as a planned, staged procedure. 