10-Year Outcome of Complete or Infarct-Artery-Only Revascularization in STEMI with Multivessel Disease (DANAMI-3-PRIMULTI)

Jasmine M Marquard; Rasmus P Beske; Henning Kelbæk; Lene Holmvang; Frants Pedersen; Peter Clemmensen; Ole De Backer; Bent Raungaard; Ashkan Eftekhari; Utsho Islam; Lars Køber; Hans-Henrik Tilsted; Charlotte Glinge; Reza Jabbari; Thomas Scheike; Dan E Høfsten; Jacob T Lønborg; Thomas Engstrøm

doi:10.1016/j.jacc.2025.05.013

10-Year Outcome of Complete or Infarct-Artery-Only Revascularization in STEMI with Multivessel Disease (DANAMI-3-PRIMULTI)

Jasmine M Marquard^*, Rasmus P Beske, Henning Kelbæk, Lene Holmvang, Frants Pedersen, Peter Clemmensen, Ole De Backer, Bent Raungaard, Ashkan Eftekhari, Utsho Islam, Lars Køber, Hans-Henrik Tilsted, Charlotte Glinge, Reza Jabbari, Thomas Scheike, Dan E Høfsten, Jacob T Lønborg, Thomas Engstrøm

^*Corresponding author af dette arbejde

Afdeling for Hjertesygdomme

Abstract

BACKGROUND: The long-term outcomes of complete revascularization in ST-segment elevation myocardial infarction (STEMI) and multivessel disease is unknown.

OBJECTIVES: To investigate the 10-year clinical outcomes including repeated events of fractional flow reserve (FFR)-guided complete revascularization versus treatment of the infarct-related artery only in STEMI.

METHODS: This 10-year follow-up study of the DANAMI-3-PRIMULTI trial included patients with STEMI and ≥1 angiographically significant non-infarct-related lesion, randomized to FFR-guided complete revascularization or infarct-related artery only after the index procedure. As the original trial, the primary outcome was a composite of all-cause mortality, recurrent myocardial infarction, or any revascularization. Repeated events of revascularization and myocardial infarction were analyzed.

RESULTS: Of 627 included patients, 313 were randomized to infarct-related artery only and 314 to complete revascularization. After 10 years, complete revascularization reduced the risk of the primary outcome (hazard ratio 0.76 (95% confidence interval (CI), 0.60-0.94) p=0.014). In the infarct-related artery only group, 78 (25%) died vs. 74 (24%) in the complete revascularization group. Complete revascularization reduced any revascularization compared with infarct-related artery only (odds ratio. 0.62 (95% CI: 0.44-0.89)). There was no difference in recurrent myocardial infarction (odds ratio, 0.90 (95% CI, 0.60-1.35)). The mean cumulative number of events were 76/100 persons (95% CI, 66-88) in the infarct-related artery only group vs. 63 events/100 persons (95% CI, 54-73) in the complete revascularization group (absolute reduction, 13% (95% CI, -1%-28%)).

CONCLUSIONS: FFR-guided complete revascularization reduced future and repeated events compared with infarct-related artery only after 10 years. The risk was mainly driven by revascularization, with no reduction in myocardial infarctions or death.

Originalsprog	Engelsk
Tidsskrift	Journal of the American College of Cardiology
ISSN	0735-1097
DOI	https://doi.org/10.1016/j.jacc.2025.05.013
Status	E-pub ahead of print - 8 maj 2025

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10.1016/j.jacc.2025.05.013

Citationsformater

Marquard, J. M., Beske, R. P., Kelbæk, H., Holmvang, L., Pedersen, F., Clemmensen, P., De Backer, O., Raungaard, B., Eftekhari, A., Islam, U., Køber, L., Tilsted, H.-H., Glinge, C., Jabbari, R., Scheike, T., Høfsten, D. E., Lønborg, J. T., & Engstrøm, T. (2025). 10-Year Outcome of Complete or Infarct-Artery-Only Revascularization in STEMI with Multivessel Disease (DANAMI-3-PRIMULTI). Journal of the American College of Cardiology. Advance online publication. https://doi.org/10.1016/j.jacc.2025.05.013

Marquard, JM , Beske, RP, Kelbæk, H, Holmvang, L , Pedersen, F, Clemmensen, P, De Backer, O, Raungaard, B, Eftekhari, A, Islam, U , Køber, L , Tilsted, H-H , Glinge, C , Jabbari, R, Scheike, T, Høfsten, DE , Lønborg, JT & Engstrøm, T 2025, '10-Year Outcome of Complete or Infarct-Artery-Only Revascularization in STEMI with Multivessel Disease (DANAMI-3-PRIMULTI)', Journal of the American College of Cardiology. https://doi.org/10.1016/j.jacc.2025.05.013

@article{72fa665b7f6048aba30dcfb471b51e2f,

title = "10-Year Outcome of Complete or Infarct-Artery-Only Revascularization in STEMI with Multivessel Disease (DANAMI-3-PRIMULTI)",

abstract = "BACKGROUND: The long-term outcomes of complete revascularization in ST-segment elevation myocardial infarction (STEMI) and multivessel disease is unknown.OBJECTIVES: To investigate the 10-year clinical outcomes including repeated events of fractional flow reserve (FFR)-guided complete revascularization versus treatment of the infarct-related artery only in STEMI.METHODS: This 10-year follow-up study of the DANAMI-3-PRIMULTI trial included patients with STEMI and ≥1 angiographically significant non-infarct-related lesion, randomized to FFR-guided complete revascularization or infarct-related artery only after the index procedure. As the original trial, the primary outcome was a composite of all-cause mortality, recurrent myocardial infarction, or any revascularization. Repeated events of revascularization and myocardial infarction were analyzed.RESULTS: Of 627 included patients, 313 were randomized to infarct-related artery only and 314 to complete revascularization. After 10 years, complete revascularization reduced the risk of the primary outcome (hazard ratio 0.76 (95% confidence interval (CI), 0.60-0.94) p=0.014). In the infarct-related artery only group, 78 (25%) died vs. 74 (24%) in the complete revascularization group. Complete revascularization reduced any revascularization compared with infarct-related artery only (odds ratio. 0.62 (95% CI: 0.44-0.89)). There was no difference in recurrent myocardial infarction (odds ratio, 0.90 (95% CI, 0.60-1.35)). The mean cumulative number of events were 76/100 persons (95% CI, 66-88) in the infarct-related artery only group vs. 63 events/100 persons (95% CI, 54-73) in the complete revascularization group (absolute reduction, 13% (95% CI, -1%-28%)).CONCLUSIONS: FFR-guided complete revascularization reduced future and repeated events compared with infarct-related artery only after 10 years. The risk was mainly driven by revascularization, with no reduction in myocardial infarctions or death.",

author = "Marquard, {Jasmine M} and Beske, {Rasmus P} and Henning Kelb{\ae}k and Lene Holmvang and Frants Pedersen and Peter Clemmensen and {De Backer}, Ole and Bent Raungaard and Ashkan Eftekhari and Utsho Islam and Lars K{\o}ber and Hans-Henrik Tilsted and Charlotte Glinge and Reza Jabbari and Thomas Scheike and H{\o}fsten, {Dan E} and L{\o}nborg, {Jacob T} and Thomas Engstr{\o}m",

year = "2025",

month = may,

day = "8",

doi = "10.1016/j.jacc.2025.05.013",

language = "English",

journal = "Journal of the American College of Cardiology",

issn = "0735-1097",

publisher = "Elsevier Inc.",

}

TY - JOUR

T1 - 10-Year Outcome of Complete or Infarct-Artery-Only Revascularization in STEMI with Multivessel Disease (DANAMI-3-PRIMULTI)

AU - Marquard, Jasmine M

AU - Beske, Rasmus P

AU - Kelbæk, Henning

AU - Holmvang, Lene

AU - Pedersen, Frants

AU - Clemmensen, Peter

AU - De Backer, Ole

AU - Raungaard, Bent

AU - Eftekhari, Ashkan

AU - Islam, Utsho

AU - Køber, Lars

AU - Tilsted, Hans-Henrik

AU - Glinge, Charlotte

AU - Jabbari, Reza

AU - Scheike, Thomas

AU - Høfsten, Dan E

AU - Lønborg, Jacob T

AU - Engstrøm, Thomas

PY - 2025/5/8

Y1 - 2025/5/8

N2 - BACKGROUND: The long-term outcomes of complete revascularization in ST-segment elevation myocardial infarction (STEMI) and multivessel disease is unknown.OBJECTIVES: To investigate the 10-year clinical outcomes including repeated events of fractional flow reserve (FFR)-guided complete revascularization versus treatment of the infarct-related artery only in STEMI.METHODS: This 10-year follow-up study of the DANAMI-3-PRIMULTI trial included patients with STEMI and ≥1 angiographically significant non-infarct-related lesion, randomized to FFR-guided complete revascularization or infarct-related artery only after the index procedure. As the original trial, the primary outcome was a composite of all-cause mortality, recurrent myocardial infarction, or any revascularization. Repeated events of revascularization and myocardial infarction were analyzed.RESULTS: Of 627 included patients, 313 were randomized to infarct-related artery only and 314 to complete revascularization. After 10 years, complete revascularization reduced the risk of the primary outcome (hazard ratio 0.76 (95% confidence interval (CI), 0.60-0.94) p=0.014). In the infarct-related artery only group, 78 (25%) died vs. 74 (24%) in the complete revascularization group. Complete revascularization reduced any revascularization compared with infarct-related artery only (odds ratio. 0.62 (95% CI: 0.44-0.89)). There was no difference in recurrent myocardial infarction (odds ratio, 0.90 (95% CI, 0.60-1.35)). The mean cumulative number of events were 76/100 persons (95% CI, 66-88) in the infarct-related artery only group vs. 63 events/100 persons (95% CI, 54-73) in the complete revascularization group (absolute reduction, 13% (95% CI, -1%-28%)).CONCLUSIONS: FFR-guided complete revascularization reduced future and repeated events compared with infarct-related artery only after 10 years. The risk was mainly driven by revascularization, with no reduction in myocardial infarctions or death.

AB - BACKGROUND: The long-term outcomes of complete revascularization in ST-segment elevation myocardial infarction (STEMI) and multivessel disease is unknown.OBJECTIVES: To investigate the 10-year clinical outcomes including repeated events of fractional flow reserve (FFR)-guided complete revascularization versus treatment of the infarct-related artery only in STEMI.METHODS: This 10-year follow-up study of the DANAMI-3-PRIMULTI trial included patients with STEMI and ≥1 angiographically significant non-infarct-related lesion, randomized to FFR-guided complete revascularization or infarct-related artery only after the index procedure. As the original trial, the primary outcome was a composite of all-cause mortality, recurrent myocardial infarction, or any revascularization. Repeated events of revascularization and myocardial infarction were analyzed.RESULTS: Of 627 included patients, 313 were randomized to infarct-related artery only and 314 to complete revascularization. After 10 years, complete revascularization reduced the risk of the primary outcome (hazard ratio 0.76 (95% confidence interval (CI), 0.60-0.94) p=0.014). In the infarct-related artery only group, 78 (25%) died vs. 74 (24%) in the complete revascularization group. Complete revascularization reduced any revascularization compared with infarct-related artery only (odds ratio. 0.62 (95% CI: 0.44-0.89)). There was no difference in recurrent myocardial infarction (odds ratio, 0.90 (95% CI, 0.60-1.35)). The mean cumulative number of events were 76/100 persons (95% CI, 66-88) in the infarct-related artery only group vs. 63 events/100 persons (95% CI, 54-73) in the complete revascularization group (absolute reduction, 13% (95% CI, -1%-28%)).CONCLUSIONS: FFR-guided complete revascularization reduced future and repeated events compared with infarct-related artery only after 10 years. The risk was mainly driven by revascularization, with no reduction in myocardial infarctions or death.

U2 - 10.1016/j.jacc.2025.05.013

DO - 10.1016/j.jacc.2025.05.013

M3 - Journal article

C2 - 40392668

SN - 0735-1097

JO - Journal of the American College of Cardiology

JF - Journal of the American College of Cardiology

ER -

10-Year Outcome of Complete or Infarct-Artery-Only Revascularization in STEMI with Multivessel Disease (DANAMI-3-PRIMULTI)

Abstract

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