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 hospitalization (72% underwent multivessel primary PCI). The composite 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: 0.49; 95% CI: (Third Danish Study of Optimal Acute Treatment of Patients with ST-segment Elevation Myocardial Infarc- tion) trial (17), the composite primary outcome of all-cause death, nonfatal MI, or ischemia-driven revas- cularization of nonculprit artery disease occurred in 40 of 314 patients (13%) who underwent multivessel staged PCI guided by angiography and fractional ow reserve before discharge, versus 68 of 313 patients (22%) treated with culprit artery only PCI (HR: 0.56; 95% CI: 0.38 to in Patients Transferred From General Community Hospi- tals to Specialized PTCA Units With or Without Emer- gency Thrombolysis) trial (27), 214 patients with STEMI were randomized to staged (3 to 40 days after the index procedure) revascularization of all $70% diameter ste- nosis noninfarct lesions or culprit-only PCI. Preliminary results at 38 months mean follow-up showed no between-group differences in the composite primary endpoint of all-cause death, nonfatal MI, and stroke. On the basis of these ndings (17,18,24,27), the prior Class III (Harm) recommendation with regard to multi- vessel primary PCI in hemodynamically stable patients with STEMI has been upgraded and modi ed to a Class IIb recommendation to include consideration of multivessel PCI, either at the time of primary PCI or as a planned, staged procedure. The writing committee emphasizes that this change should not be interpreted as endorsing the routine performance of multivessel PCI in all patients with STEMI and multivessel disease. 