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
N1 - Copyright © 2025 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
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.
KW - complete revascularization
KW - multivessel disease
KW - prognosis
KW - randomized trial
KW - STEMI
UR - http://www.scopus.com/inward/record.url?scp=105009302266&partnerID=8YFLogxK
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 -