The DANAMI-3-PRIMULTI trial included 627 patients with ST-elevation myocardial infarction (STEMI) and multivessel coronary artery disease (MVD), all with at least one angiographically significant non-culprit lesion. Patients were randomized 1:1 to either FFR-guided complete revascularization or culprit-only PCI.
The original study was published in 2015, and in this opportunity, the 10-year follow-up was presented, assessing a primary composite outcome of all-cause mortality, acute myocardial infarction (AMI), or repeat revascularization.
At 10 years, the culprit-only strategy had an event rate of 54%, while the complete revascularization group had an incidence of 45%, showing a 24% reduction in the primary composite outcome (HR 0.76; 95% CI 0.60–0.94; p=0.014).
Event distribution analysis revealed that the reduction was mainly driven by fewer repeat revascularizations (HR 0.62), particularly in non-culprit vessels (HR 0.48).
In absolute terms, there was a cumulative reduction of 13 events every 100 treated patients.
Read also: EuroPCR 2025 | Angiography- vs. Physiology-Guided PCI in TAVI Candidates (FAITAVI).
Therefore, the authors concluded that FFR-guided complete revascularization in STEMI patients with MVD can be safely performed and results in a significant long-term reduction in events, mainly due to fewer revascularization procedures.
Presented by T. Engstrom during the Major Late Breaking Trials session, EuroPCR 2025, May 21, Paris, France.
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