Collateral flow to the territory of the occluded infarct-related artery: percutaneous coronary intervention or no percutaneous coronary intervention: why does the gold not always glitter?

Time and time again, randomized clinical trials have demonstrated that what is conceptually logical and should be right is not always right. Randomized large clinical trials are often undertaken on the basis of this logical hypothesis. Very often, small clinical trials also show encouraging results.1,2 However, when large randomized clinical trials are performed, they not infrequently reveal rather disappointing and unexpected results. The study by Steg et al, “Impact of Collateral Flow to the Occluded Infarct-Related Artery on Clinical Outcomes in Patients with Recent Myocardial Infarction: A Report From the Randomized Occluded Artery Trial,” reported in this issue of Circulation, proves this again.3