Key result
Deferring PCI of non-culprit lesions with FFR >0.80 in STEMI patients was associated with a higher risk of mortality, MI, or urgent revascularization compared to performing PCI.
Why the study?
Whether non-culprit lesions in patients with STEMI and multivessel disease should be evaluated using angiography or FFR remains uncertain.
Does deferring PCI of non-culprit lesions based on FFR > 0.80 increase the risk of adverse cardiovascular events compared to performing PCI on FFR-positive lesions in patients with STEMI and multivessel disease?
Cohort (n=280)
Does deferring PCI of non-culprit lesions based on FFR > 0.80 increase the risk of adverse cardiovascular events compared to performing PCI on FFR-positive lesions 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 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. 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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Islam et al. (2026) conducted a cohort in STEMI and multivessel disease (n=280). Deferral of PCI for non-culprit lesions (FFR > 0.80) vs. PCI of at least one non-culprit lesion (FFR ≤ 0.80 or angiographical diameter stenosis ≥90%) was evaluated on All-cause mortality, myocardial infarction, or urgent revascularization (adjusted HR 0.64, 95% CI 0.44-0.95, p=0.025). Deferring PCI of non-culprit lesions with FFR >0.80 in STEMI patients was associated with a higher risk of mortality, MI, or urgent revascularization compared to performing PCI.
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