These variations have contributed to the dispa- rate findings reported, although there seems to be a clear trend toward lower rates of adverse outcomes when primary PCI is lim- ited to the infarct artery and PCI of a noninfarct artery is under- taken in staged fashion at a later time.216,224,225,383,384 The largest of these observational studies compared 538 patients undergo- ing staged multivessel PCI within 60 days of primary PCI with propensity-matched individuals who had culprit-vessel PCI Multivessel PCI was associated with a lower mortality rate at 1 year (1.3% versus 3.3%; P=0.04).A nonsignificant trend toward a lower mortality rate at 1 year was observed in the sub- set of 258 patients who underwent staged PCI during the initial Table 10. Indications for PCI of an Infarct Artery in Patients Who Were Managed With Fibrinolytic Therapy or Who Did Not Receive Reperfusion Therapy COR LOE References Cardiogenic shock or acute severe HF I B 354 Intermediate- or high-risk findings on predischarge noninvasive ischemia testing I C 232, 233 Spontaneous or easily provoked myocardial ischemia I C N/A Patients with evidence of failed reperfusion or reocclusion after fibrinolytic therapy (as soon as possible) IIa B 344 347 Stable* patients after successful fibrinolysis, ideally between 3 and 24 h IIa B 358 363 Delayed PCI of a totally occluded infarct artery >24 h after STEMI in stable patients III: No Benefit B 213, 376 *Although individual circumstances will vary, clinical stability is defined by the absence of low output, hypotension, persistent tachycardia, apparent shock, high- grade ventricular or symptomatic supraventricular tachyarrhythmias, and spontaneous recurrent ischemia. COR indicates Class of Recommendation; HF, heart failure; LOE, Level of Evidence; N/A, not available; PCI, percutaneous coronary intervention; and STEMI, ST-elevation myocardial infarction. 