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Decision-making between percutaneous and surgical revascularization in patients with multivessel coronary artery disease (CAD) is challenging. Current guidelines recommend surgery as the preferred revascularization strategy in patients with multivessel disease, and the 5-year SYNTAX trial results published this year further validates this. However, last-generation drug-eluting stents might challenge surgery in the contemporary setting.

Comparisons of sodium chloride and sodium bicarbonate for the prevention of contrast-induced acute kidney injury have produced inconclusive results. A new study by Klima et al. shows that sodium chloride provides greater renal protection than does sodium bicarbonate following exposure to contrast medium. However, this finding should be interpreted with caution.

In 2012, results from three studies in interventional cardiology have enhanced our knowledge on the best practices to improve clinical outcomes. These trials were focused on treatment safety as well as efficacy. The optimal therapeutic strategy for patients undergoing percutaneous coronary intervention continues to evolve.

Antithrombotic therapy during percutaneous coronary intervention for ST-segment elevation myocardial infarction has evolved substantially over the past 15 years. With the results of the ATOLL trial, enoxaparin should now be considered a therapeutic alternative to unfractionated heparin in the treatment of such patients. Comparative studies of enoxaparin and bivalirudin, using standardized bleeding definitions, are warranted.

The optimal reperfusion strategy in patients with ST-segment elevation myocardial infarction (STEMI) and multivessel disease is still uncertain. In this Review, Mehran and colleagues discuss the available evidence on the different treatment options for patients with STEMI and multivessel disease, highlighting current guideline recommendations and providing future directions on reperfusion strategies in these patients.

The REVIVED trial provides critical evidence on the management of patients with ischemic left ventricular dysfunction, highlighting the importance of optimal medical therapy. At the same time, it is another reminder of the fact that we are far from reaching adequate representation of women in cardiovascular disease trials.

Novel oral anticoagulants (direct thrombin or factor Xa inhibitors) have become alternative options to vitamin K antagonists owing to their predictable and safe pharmacological profiles. In this Review, Baber and colleagues discuss the overall clinical effect of these drugs, which is a balance between ischaemic benefit and bleeding risk, in patients with atrial fibrillation, venous thromboembolism, or acute coronary syndrome.

Patients with coronary artery disease (CAD) are at high risk of perioperative cardiovascular complications related to non-cardiac surgery. In this Review, Mehran and colleagues summarize trial data and guideline recommendations on preoperative risk stratification and periprocedural management of patients with CAD undergoing non-cardiac surgery.

ST-segment elevation myocardial infarction (STEMI) is an acute coronary syndrome in which transmural ischaemia (mostly caused by the formation of a thrombus on a ruptured atherosclerotic plaque) leads to cardiomyocyte death. STEMI is associated with considerable morbidity and mortality worldwide.

Early detection of signs of heart failure can allow fast therapeutic intervention, potentially improving a patient's prognosis and avoiding unnecessary hospitalizations. Implantable monitoring devices have been suggested as useful tools in detecting early changes in cardiac parameters, but clinical trials aimed at studying their efficacy and safety have unique problems. In this Review, Abraham et al. identify the major hurdles in trials of implantable monitoring devices, and discuss the approaches used to overcome the challenges arising during trial design.

Percutaneous coronary intervention (PCI) for a chronic total occlusion (CTO) is currently infrequently performed due to technical difficulty or perceived risk of complication. In this Review, Hoebers et al, provide a comprehensive overview of CTO–PCI and the selection criteria for those patients who might benefit from the procedure, which the authors believe should be performed more frequently to treat CTOs. The authors also discuss emerging technologies that might improve CTO–PCI.