The aim of this study was to compare the usefulness of primary angioplasty only to culprit vessel versus complete revascularization guided by fractional flow reserve (FFR) in patients admitted pursuing an acute myocardial infarction with ST-segment elevation and have multiple injuries vessels. After a successful primary angioplasty to culprit artery, patients were randomized 1:1 to continue with medical treatment (n = 313) or full-driven revascularization guided by FFR, before discharge (n = 314). The mean time between primary angioplasty and angioplasty to other vessels was 2 days and in 93% of patients drug-eluting stents were used. Follow-up was 27 months.
The combined primary end point (death from any cause, myocardial infarction, ischemia-driven revascularization of the not guilty vessel) was 22% for angioplasty only to the culprit artery and 13% to multiple vessels with FFR (p = 0.004). The benefit was similar primarily by less ischemia-driven revascularization in not guilty vessels (5% versus 17%, p <0.001), with mortality (5% versus 4%, p = 0.43) and nonfatal myocardial infarction (5% versus 5%, p = 0.87).
Conclusion
Patients with multivessel entering pursuing an ST segment myocardial infarction and receive a successful primary angioplasty benefit of the angioplasty to the rest of the vessels guided by FFR before discharge.
Thomas Engstrom
2015-03-18
Original title: The Third DANish Study of Optimal Acute Treatment of Patients With STEMI: PRImary PCI in MULTIvessel Disease Clinical Trial – DANAMI3- PRIMULTI.
