TY - JOUR JO - EuroIntervention TI - Characterisation of lesions undergoing ischaemia-driven revascularisation after complete revascularisation versus culprit lesion only in patients with STEMI and multivessel disease: a DANAMI-3-PRIMULTI substudy AB - <p><strong>Aims:</strong> Treatment of the infarct-related artery only (IRA only) in ST-segment elevation myocardial infarction (STEMI) is associated with a significantly higher rate of ischaemia-driven revascularisation (ID-RV) during follow-up than fractional flow reserve-guided complete revascularisation (FFR-CRV). This study aimed to characterise all lesions which underwent ID-RV in the DANAMI-3-PRIMULTI trial with respect to location, stenosis grade and functional significance.</p> <p><strong>Methods and results:</strong> The study included 627 patients with STEMI and multivessel disease; 313 patients were randomised to treatment of the IRA only versus 314 undergoing staged FFR-CRV during the index admission. Rates of admission for suspected cardiac ischaemia (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&lt;0.001). In both groups, the primary reason for ID-RV was related to non-culprit, non-treated lesions (N=71/82 lesions in IRA-only; N=13/26 in FFR-CRV). De novo lesions or revascularisation 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 &ndash; in particular, &ge;80% stenosis of the left anterior descending and right coronary artery also led to angina class IV/unstable angina. In the FFR-CRV group, an FFR value &le;0.80 was shown to be an appropriate threshold for revascularisation.</p> <p><strong>Conclusions:</strong> FFR-CRV in STEMI is associated with a significantly lower rate of ID-RV at follow-up than treatment of the IRA only. This is due to a difference in non-culprit, non-treated lesions between both groups and not in de novo lesions or repeat revascularisation 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.</p> AU - De Backer Ole AU - Lønborg Jacob AU - Helqvist Steffen AU - Warnøe Julie AU - Kløvgaard Lene AU - Holmvang Lene AU - Pedersen Frants AU - Tilsted Hans-Henrik AU - Raungaard Bent AU - Jørgensen Erik AU - Køber Lars AU - Høfsten Eik Dan AU - Kelbæk Henning AU - Engstrøm Thomas VL - 15 IS - 2 Y1 - 20/06/2019 Y1 - 2019 DOI - 10.4244/EIJ-D-18-00766 SP - 172 EP - 179 KW - stemi KW - fractional flow reserve KW - multivessel disease PB - Europa Digital & Publishing SE - Coronary interventions UR - https://eurointervention.pcronline.com/article/characterization-of-lesions-undergoing-ischemia-driven-revascularization-after-complete-revascularization-versus-culprit-lesion-only-in-patients-with-stemi-and-multivessel-disease-ndash-a-danami-3-primulti-substudy- SN - 1774-024X ER -