Ten-year target lesion failure in patients treated with primary PCI: results from DANAMI-3

Background Primary percutaneous coronary intervention (PCI) has significantly improved outcomes for ST-segment elevation myocardial infarction (STEMI) patients. However, the long-term durability of PCI in terms of target lesion failure (TLF) remains unknown. Objectives This study investigates the long-term incidence, predictors and clinical impact of TLF over a 10-year follow-up in STEMI patients treated with primary PCI. Methods From the DANAMI-3 trial, we analysed STEMI patients treated with primary PCI. TLF was defined as a composite of cardiovascular death, target lesion myocardial infarction or target lesion revascularisation. Independent predictors of TLF were identified by Cox regression. Outcomes in high-risk and low-risk groups were evaluated using cumulative incidence functions with competing risk analysis. Results Of 2217 patients (median follow-up of 10.7 years), 443 (20.0%) experienced TLF. TLF occurred in 5.6% within the first year after PCI and continued at a constant annual rate of 1.6% thereafter. All-cause mortality, any MI or any revascularisation occurred in 961 (43%) patients, and TLF constitutes 46% of the total patient-oriented events. Multivariable Cox regression identified age, hypertension, previous AMI and Killip class II–IV as independent predictors of an increased risk of TLF, whereas PCI with drug-eluting stents was associated with a reduced risk of TLF. Patients with ≥1 high-risk feature had a twofold greater risk of TLF compared with those without (HR 2.05, 95%CI 1.65 to 2.55, p<0.001). Conclusions One in five STEMI patients treated with primary PCI experiences TLF within 10 years, accounting for a significant proportion of any mortality, any MI or any revascularisation, with sustained occurrence rates beyond the first year.