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Characterization of lesions undergoing ischemia-driven revascularization after complete revascularization versus culprit lesion only in patients with STEMI and multivessel disease - A DANAMI-3-PRIMULTI substudy Association of Silent Myocardial Infarction and Sudden Cardiac Death Ticagrelor or Prasugrel in Patients with Acute Coronary Syndromes Response by Kaier et al to Letter Regarding Article, “Direct Comparison of Cardiac Myosin-Binding Protein C With Cardiac Troponins for the Early Diagnosis of Acute Myocardial Infarction” Circulating MicroRNAs and Monocyte-Platelet Aggregate Formation in Acute Coronary Syndrome A prospective, randomized, open-label trial of 6-month versus 12-month dual antiplatelet therapy after drug-eluting stent implantation in ST-elevation myocardial infarction: Rationale and design of the Alirocumab Reduces Total Nonfatal Cardiovascular and Fatal Events in the ODYSSEY OUTCOMES Trial Sex differences in discharge destination following acute myocardial infarction
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Original Research2019 Jan 22. pii: EIJ-D-18-00766.

JOURNAL：EuroIntervention. Article Link

Characterization of lesions undergoing ischemia-driven revascularization after complete revascularization versus culprit lesion only in patients with STEMI and multivessel disease - A DANAMI-3-PRIMULTI substudy

De Backer O, Lønborg J, Helqvist S et al. Keywords: infarct-related artery only revascularization; ischemia-driven revascularization; fractional flow reserve-guided complete revascularization

ABSTRACT

AIMS - Treatment of the infarct-related artery only (IRA-only) in ST-segment elevation myocardial infarction (STEMI) is associated with a significantly higher rate of ischemia-driven revascularization (ID-RV) during follow-up than fractional flow reserve-guided complete revascularization (FFR-CRV).

 

METHODS AND RESULTS - In this study, we characterized the lesions that underwent ID-RV in the DANAMI-3-PRIMULTI-trial (n=627) with respect to location, angiographic diameter stenosis and functional significance. Rates of admission for suspected cardiac ischemia (17%) were similar in both groups; however, ID-RV was significantly less frequent in the FFR-CRV group than in the IRA-only group (5% vs. 17%; p<0.001). In both groups, the primary reason for ID-RV were non-culprit, non-treated lesions (N=71/82 lesions in IRA-only; N=13/26 in FFR-CRV). De-novo lesions or revascularization of previously treated lesions were rarely causes of ID-RV. In the IRA-only group, there was a trend towards a higher ID-RV-rate for lesions with a higher stenosis grade and located in more proximal segments - in particular ≥80% stenosis of left anterior descending and right coronary artery also led to angina class IV/unstable angina. In the FFR-CRV group, a FFR-value ≤0.80 showed to be an appropriate threshold for revascularization.

 

CONCLUSIONS - FFR-CRV in STEMI is associated with a significantly lower rate of ID-RV at follow-up than treatment of the IRA-only - this due to a difference in non-culprit, non-treated lesions between both groups and not in de-novo lesions or repeat revascularization of previously treated lesions. Further considerations are warranted in case of high-grade non-culprit stenosis at proximal coronary segments, borderline FFR-values and/or anticipated complex PCI.

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