http://www.bbc.co.uk/news/uk-scotland-24039908

Is it just me or does this seem blindingly obvious?
You've got to wonder why they haven't been doing this for years.

I did wonder about that myself.

Probably cost, though doing all the arteries at the same time probably adds very little to the overall cost of the procedure.

That's what I was thinking.

Are you people illiterate?

It says in the story linked:
"Most cardiologists thought it wasn't safe to treat a second or third artery at the same time as the first artery," Prof Oldroyd said.

1. Generally, you treat the acute problem first and worry about everything else later. In a heart attack, an artery is blocked so if you unblock it quickly enough, you reverse the damage. The patient may remain critically unwell for a few hours/days after so you don't do the unnecessary there and then.

2. Risks - something people forget. I used to consent patients for angiograms and angioplasty. Arrhythmias, heart attack, stroke, and death are some of the more serious risks. The risk of death is around 1:200. Never seen anyone die but have seen plenty have arrhythmias and I think three people had a stroke following the procedure.

3. Non-limiting disease. You can have narrowed arteries and never have a heart attack. It merely increases your risk. After a heart attack and angioplasty, you will go further assessment to see whether the other arteries are causing any problems. If not, they're left alone. If they do, you might undergo elective treatment.

4. You can still get further narrowing years down the line so you would need to restent, which is more difficult than doing a fresh artery.

5. Having a stent increases the risk of that stent blocking and causing another heart attack. Have seen this happen in two patients.

Thought - past tense.
I still find it strange they didn't look into it before now. Yes, there's always risk in operations. But if they're already in there, the risk of continuing has got to be less than a whole new operation at a future date. But then future complictaions aren't that surgens problem.

As I've mentioned, the risk for elective procedures is different to the risk for emergency procedures. If someone's bleeding because their leg has been chopped off, you're going to stabilise the patient and sort the immediate problem out. You're not gonna say "you know, this hip joint looks a little worn - let's do a hip operation".

There's also the issue of consent - it's medicolegally acceptable to treat the immediate problem but not acceptable to start treating other problems. Example: patient has a ruptured spleen and goes in for emergency surgery. During the op, the surgeon fines a cancerous ovary. Does he take it out? Answer - no. It's not immediately life threatening. If the patient was conscious prior to surgery, they may have signed a consent form to say they're happy for the spleen to be taken out - and that's all you do. If there's other immediate life threatening issues eg punctured lung, then it would be appropriate to address it there and then.

Is there any reason why a patient can't come back when they're better/well/recovered from the heart attack and have the stents put in electively?

It might be a matter of time before they have to do exactly that. As the next artery becomes clogged. Also aren't surgeons reluctant to operate through previous operation scar tissue?

I was just lazy and didn't read that far down

I think if it was me, I'd want to do them all at the same time.

Yes I think I would too. I would probably tick a box saying do anything else necessary while in there, so no need to come back. Each operation has its risks, and they would not necessarily start on a new artery until they were sure that the first was fixed.