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Our case demonstrates that rapid and complete revascularization by PCI can save a patient with acute myocardial infarction caused by simultaneous acute occlusion of the three major coronary arteries.We present a case in which optical coherence tomography was useful to characterize in vivo superficial calcific sheet and exclude other causes of acute coronary syndromes.In the current era of transcatheter edge-to-edge repair, deciding clip size in each case is still a challenge. We demonstrate that the XTR clip can achieve a better outcome