PRAMI 2013.

Methods	RCT multi‐centre. Randomisation ratio: 1:1. Number of study centres: 5 centres in the UK.
Participants	Inclusion criteria: people of any age with STEMI and MVD detected at the time of angiography. Exclusion criteria: cardiogenic shock, unable to provide consent, previous CABG, non‐infarct artery stenosis of͵≥ 50% in the left main stem or the ostial branch of both the left anterior descending and circumflex arteries (because these are indications for CABG), or if the only non‐infarct stenosis was a chronic total occlusion (because it was felt that PCI in such circumstances was contraindicated owing to a low success rate). Diagnostic criteria MVD: presence of significant stenosis in ≥ 1 coronary artery other than the culprit vessel. Significant stenosis: stenosis ≥ 50%. Sample size: complete revascularisation n = 234 and culprit‐only revascularisation n = 231.
Interventions	Complete revascularisation: intervention on all, culprit and non‐culprit arteries with stenosis of ≥ 50%. Culprit‐only revascularisation: PCI of culprit vessel only, except in people with refractory angina with objective evidence of ischaemia which may require staged intervention.
Outcomes	Primary: composite of death from cardiac causes, non‐fatal MI, or refractory angina. Secondary: death from non‐cardiac causes and revascularisation procedure.
Notes	Study was stopped earlier because of a highly significant difference between groups, favouring the complete revascularisation group. The study was funded by Bart's and the London Trust (BLT) Charitable Foundation (UK). Protocol ID: ISRCTN73028481.
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	Randomisation was computer‐generated.
Allocation concealment (selection bias)	Unclear risk	Not mentioned how allocation concealment was insured.
Blinding of participants and personnel (performance bias) All outcomes	High risk	Study was open label for the participant.
Blinding of outcome assessment (detection bias) All outcomes	Low risk	Independent cardiologist and cardiac surgeon who were not notified about study‐group assignments examined specified primary and secondary outcomes.
Incomplete outcome data (attrition bias) All outcomes	High risk	Similar dropout rate in both groups, 4.3% in the complete vs 3.5% in the culprit‐only intervention group; however, given the small number of events, the results may be susceptible to attrition bias.
Selective reporting (reporting bias)	Low risk	Study reported the primary outcomes indicated in the published protocol in www.isrctn.com ISRCTN73028481.
Other bias	High risk	Early termination of the study may overestimate/underestimate certain differences.