Key result
PCI of FFR-positive non-culprit lesions reduced the composite of mortality, MI, or urgent revascularization compared to PCI deferral.
Why the study?
Whether non-culprit lesions in STEMI and multivessel disease should be evaluated using angiography or fractional flow reserve remains uncertain.
Does PCI of FFR-positive non-culprit lesions improve long-term outcomes compared to deferring PCI based on FFR > 0.80 in patients with STEMI and multivessel disease?
RCT (n=280)
Randomized
Does PCI of FFR-positive non-culprit lesions improve long-term outcomes compared to deferring PCI based on FFR > 0.80 in patients with STEMI and multivessel disease?
Answers are grounded in this paper and cite their sources.
In STEMI patients with multivessel disease, deferring PCI of non-culprit lesions based on FFR > 0.80 was associated with a higher risk of long-term adverse cardiovascular events compared to performing PCI on FFR-positive lesions.
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. Purpose 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 a percutaneous coronary intervention (PCI). Methods Of the 627 patients included in the DANAMI-3-PRIMULTI (The Third DANish Study of Optimal Acute Treatment of Patients with STEMI: PRImary PCI in MULTIvessel Disease) trial, the 280 patients were randomized to FFR-guided complete revascularization and included in this sub-study. 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. No significant difference was observed in all-cause mortality (adjusted HR 0.62, CI 95% 0.68 – 1.01, p = 0.06), myocardial infarction (adjusted HR 0.87, CI 95% 0.47 – 1.61, p = 0.66), and urgent revascularization (adjusted HR 0.63, CI 95% 0.34 – 1.17, p = 0.14). 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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Islam et al. (2025) conducted an RCT in ST-segment elevation myocardial infarction (STEMI) and multivessel disease (n=280). PCI of non-culprit lesions (FFR ≤ 0.80 or angiographical diameter stenosis ≥ 90%) vs. PCI-deferral (FFR > 0.80) was evaluated on All-cause mortality, myocardial infarction, or urgent revascularization (adjusted HR 0.64, 95% CI 0.44-0.95, p=0.025). PCI of FFR-positive non-culprit lesions reduced the composite of mortality, MI, or urgent revascularization compared to PCI deferral.
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