Complete Revascularization Offers Long-Term Advantage in STEMI With Multivessel Disease, Study Finds
Denmark: A decade after undergoing primary treatment, patients with ST-segment elevation myocardial infarction (STEMI) and multivessel coronary artery disease who received fractional flow reserve (FFR)-guided complete revascularization showed better outcomes compared to those treated only for the culprit artery, according to results from the long-term follow-up of the DANAMI-3-PRIMULTI trial.
The study, led by Dr. Jasmine M. Marquard and colleagues from the Department of Cardiology, Rigshospitalet, Copenhagen University Hospital in Copenhagen, Denmark, was recently published in the Journal of the American College of Cardiology (JACC).
The randomized clinical trial followed 627 STEMI patients who had at least one significant non-infarct-related lesion visible on angiography. Participants were randomly assigned to undergo either complete FFR-guided revascularization or treatment limited to the infarct-related artery during the initial procedure.
The following were the key findings:
- After 10 years, complete revascularization had a favorable impact on the primary composite outcome, which included all-cause mortality, recurrent myocardial infarction, or any additional revascularization.
- Patients who received complete revascularization had a 24% lower risk of reaching the composite endpoint than those treated only for the infarct-related artery (hazard ratio 0.76).
- Death rates were similar between the two groups, with 78 patients (25%) dying in the infarct-only group and 74 patients (24%) in the complete revascularization group.
- The incidence of recurrent myocardial infarction did not differ significantly between the groups (odds ratio 0.90).
- Complete revascularization significantly reduced the need for future revascularization procedures (odds ratio 0.62).
- The infarct-related artery-only group experienced 76 events per 100 individuals, while the complete revascularization group had 63 events per 100 individuals.
- This translated to an absolute reduction of 13% in total events over 10 years in favor of complete revascularization.
The findings suggest that the long-term benefits of a comprehensive revascularization approach are primarily attributed to the reduction in repeat interventions rather than a significant change in mortality or myocardial infarction rates. The safety and durability of the FFR-guided strategy reaffirm its role in managing STEMI patients with multivessel disease.
Presenting these results at the EuroPCR 2025 Hot Line session, the investigators emphasized that the study adds important insight into the long-term management of complex coronary disease, supporting a more proactive and complete treatment approach at the time of the initial intervention.
The researchers concluded that FFR-guided complete revascularization led to a reduction in future and repeated cardiovascular events over a 10-year period compared to treating only the infarct-related artery. They noted that this benefit was mainly driven by a lower need for repeat revascularization procedures, while there were no significant differences in rates of myocardial infarction or mortality between the two groups.
Reference:
Marquard JM, Beske RP, Kelbaek H, et al. 10-year outcome of complete or infarct-artery-only revascularization in STEMI with multivessel disease (DANAMI-3-PRIMULTI). J Am Coll Cardiol. 2025;Epub ahead of print.
