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Background Methods Results Conclusions Randomized controlled trials (RCTs) of complete revascularization (CR) versus culprit‐only revascularization (COR) in patients with ST‐elevation myocardial infarction (STEMI) have shifted the recommendation for CR from class III to class I in the AHA/ACC/SCAI guidelines, but it remains unclear if the benefit of CR over COR extends to older adults, who have greater bleeding risk, comorbidity burden, and complexity of lesions. We performed a meta‐analysis to place the results of the previous RCTs in the context of the recently published FIRE trial and the subgroup analysis of the COMPLETE trial in adults ≥75 years old.We searched the literature from inception to October 21, 2023. RCTs of CR versus COR in STEMI were selected if it reported results for older adults, defined as either age > 65 years or > 75 years. Integrated hazard ratios (HRs) were calculated using random effects models. The primary outcome was major adverse cardiovascular events (MACE). Secondary outcomes were major bleeding and contrast‐associated acute kidney injury (CA‐AKI).In this meta‐analysis of 5 RCTs including 3513 older adults, CR was associated with a lower hazard of MACE than COR (HR 0.60, 95% CI 0.37–0.99, p = 0.047). Sensitivity analysis including trials that defined older adults as age > 65 years resulted in a lower hazard of MACE with CR versus COR, but not in trials that defined older adults as age > 75 years. There was no difference in the hazard of major bleeding or CA‐AKI between CR and COR.In this largest meta‐analysis to date investigating CR compared with COR in older adults with STEMI, CR was associated with reduced MACE without a concomitant increase in major bleeding or CA‐AKI compared with COR. These results can help cardiologists and geriatricians involved in shared decision‐making with patients and caregivers when contemplating whether to pursue CR in older adults. [ABSTRACT FROM AUTHOR]

We present a young female who presented with three weeks of dry cough, dizziness, shortness of breath, headache, and chest pressure. She was found to have atrial flutter, atrial fibrillation and complete heart block, and eventually diagnosed with Lyme carditis. She was also diagnosed with psittacosis based on her high risk exposure to bird feces and her symptoms of dry cough and headache that persisted despite the initiation of treatment for Lyme disease. This case highlights the need for high clinical suspicion and early treatment of Lyme carditis in younger individuals living in endemic areas., Competing Interests: The authors have no conflicts of interest to disclose.

Background: Coexistence of coronary artery fistulas and atherosclerotic coronary artery disease (CAD) is rare., Case Summary: We present a unique case of a patient initially presenting with an anterior ST-elevation myocardial infarction, subsequently found to have two-vessel CAD and an aneurysmal left coronary-to-right pulmonary artery fistula., Discussion: After discussion with the patient and a multidisciplinary discussion with the heart team, consisting of cardiovascular surgery, interventional cardiology, and vascular surgery, a percutaneous approach was chosen. He underwent successful multivessel percutaneous coronary intervention followed by fistula embolization., (© The Author(s) 2021. Published by Oxford University Press on behalf of the European Society of Cardiology.)