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10-year outcome of fractional flow reserve-guided complete revascularization in patients with ST-segment elevation myocardial infarction - A DANAMI-3 PRIMULTI substudy.

Utsho Islam·Jasmine Melissa Marquard·Ibrahim Mohammed Abdul Khalek·Henning Kelbæk·Ashkan Eftekhari·Lars Køber·Dan Eik Høfsten·Lene Holmvang·Frants Pedersen·Jacob Thomsen Lønborg·Thomas Engstrøm
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Abstract

BACKGROUND: Complete revascularization is recommended in patients with ST-segment elevation myocardial infarction (STEMI) and multivessel disease. However, whether the non-culprit lesions should be evaluated using angiography or fractional flow reserve (FFR) remains uncertain. The aim of this study was to evaluate the long-term outcome of patients with STEMI and multivessel disease who had non-culprit FFR-values >0.80 and thus deferred PCI. METHODS: Of the 627 patients included in the DANAMI-3-PRIMULTI trial, 314 patients were randomized to FFR-guided complete revascularization and 280 were included in this substudy. Patients were divided into a PCI-deferral group who had no PCI of non-culprit lesions (FFR > 0.80) (n = 106) and a PCI group encompassing patients treated with PCI of at least one non-culprit lesion (FFR ≤ 0.80 or an angiographical diameter stenosis of ≥90%) (n = 174). The combined endpoint included all-cause mortality, myocardial infarction, or urgent revascularization. RESULTS: During a median follow-up of 10.5 years (IQR 9.8-11.4), the composite outcome occurred in 62 (36%) patients in the PCI group and in 50 (47%) patients in the PCI-deferral group (adjusted HR 0.64, 95% CI: 0.44-0.95, p = 0.025). PCI-deferral was associated with a significantly higher risk of cardiovascular mortality (adjusted HR 0.48, CI 95% 0.24-0.97, p = 0.040) compared to the PCI group. CONCLUSION: In patients with STEMI and multivessel disease, deferring PCI of non-culprit lesions based on FFR > 0.80 was associated with an increased risk of the combination of all-cause mortality, myocardial infarction, or urgent revascularization as well as cardiovascular mortality compared to patients treated with PCI of FFR-positive non-culprit lesions.

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HumansFractional Flow Reserve, MyocardialFemaleST Elevation Myocardial InfarctionMaleMiddle AgedFollow-Up StudiesTreatment OutcomeAgedCoronary AngiographyPercutaneous Coronary InterventionMyocardial RevascularizationTime FactorsJournal ArticleRandomized Controlled TrialMulticenter Study

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Utsho Islam, Jasmine Melissa Marquard, Ibrahim Mohammed Abdul Khalek, Henning Kelbæk, Ashkan Eftekhari, Lars Køber, Dan Eik Høfsten, Lene Holmvang, Frants Pedersen, Jacob Thomsen Lønborg, Thomas Engstrøm. 2026-08-01. 10-year outcome of fractional flow reserve-guided complete revascularization in patients with ST-segment elevation myocardial infarction - A DANAMI-3 PRIMULTI substudy.. https://doi.org/10.1016/j.ijcard.2026.134712

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Journal Article; Randomized Controlled Trial; Multicenter Study resourceAged subjectFemale subjectFollow-Up Studies subjectHumans subjectJournal Article subjectMale subjectMiddle Aged subjectMulticenter Study subjectRandomized controlled trials study

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