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Randomized Controlled Trial
. 2025 Jul 15;86(2):119-129.
doi: 10.1016/j.jacc.2025.05.013. Epub 2025 May 20.

10-Year Outcome of Complete or Infarct Artery-Only Revascularization in STEMI With Multivessel Disease: The DANAMI-3-PRIMULTI Study

Jasmine M Marquard  1 , Rasmus P Beske  2 , Henning Kelbæk  3 , Lene Holmvang  4 , Frants Pedersen  2 , Peter Clemmensen  5 , Ole De Backer  4 , Bent Raungaard  6 , Ashkan Eftekhari  6 , Utsho Islam  2 , Lars Køber  4 , Hans-Henrik Tilsted  2 , Charlotte Glinge  2 , Reza Jabbari  2 , Thomas Scheike  7 , Dan E Høfsten  2 , Jacob T Lønborg  4 , Thomas Engstrøm  4
Affiliations
Randomized Controlled Trial

10-Year Outcome of Complete or Infarct Artery-Only Revascularization in STEMI With Multivessel Disease: The DANAMI-3-PRIMULTI Study

Jasmine M Marquard et al. J Am Coll Cardiol. .

Abstract

Background: The long-term outcomes of complete revascularization in ST-segment elevation myocardial infarction (STEMI) and multivessel disease is unknown.

Objectives: The purpose of this study was to investigate the 10-year clinical outcomes including repeated events of fractional flow reserve (FFR)-guided complete revascularization vs treatment of the infarct-related artery only in STEMI.

Methods: This 10-year follow-up study of DANAMI-3-PRIMULTI (Third DANish Study of Optimal Acute Treatment of Patients With STEMI-Complete Revascularization versus Infarct-Related Artery Only) included patients with STEMI and ≥1 angiographically significant non-infarct-related lesion, randomized to FFR-guided complete revascularization or infarct-related artery only after the index procedure. As the original trial, the primary outcome was a composite of all-cause mortality, recurrent myocardial infarction, or any revascularization. Repeated events of revascularization and myocardial infarction were analyzed.

Results: Of 627 included patients, 313 were randomized to infarct-related artery only and 314 to complete revascularization. After 10 years, complete revascularization reduced the risk of the primary outcome (HR: 0.76; 95% CI: 0.60-0.94; P = 0.014). In the infarct-related artery-only group, 78 (25%) died vs 74 (24%) in the complete revascularization group. Complete revascularization reduced any revascularization compared with infarct-related artery only (OR: 0.62; 95% CI: 0.44-0.89). There was no difference in recurrent myocardial infarction (OR: 0.90; 95% CI: 0.60-1.35). The mean cumulative number of events were 76 per 100 persons (95% CI: 66-88) in the infarct-related artery-only group vs 63 events per 100 persons (95% CI: 54-73) in the complete revascularization group (absolute reduction: 13%; 95% CI: -1% to 28%).

Conclusions: FFR-guided complete revascularization reduced future and repeated events compared with infarct-related artery only after 10 years. The risk was mainly driven by revascularization, with no reduction in myocardial infarctions or death. (Primary PCI in Patients With ST-elevation Myocardial Infarction and Multivessel Disease: Treatment of Culprit Lesion Only or Complete Revascularization [PRIMULTI]; NCT01960933).

Keywords: STEMI; complete revascularization; multivessel disease; prognosis; randomized trial.

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Conflict of interest statement

Funding Support and Author Disclosures DANAMI-3-PRIMULTI was funded by the Danish Agency for Science, Technology and Innovation and the Danish Council for Strategic Research (EDITORS, grant 09-066994). Dr Køber has received speaker honoraria from AstraZeneca, Boehringer, Novartis, and Novo Nordisk. Dr Lønborg has received an advisory board fee, an unrestricted grant, and speaker fee from Boston Scientific and a speaker fee from Abbott, unrelated to this topic. Dr Engstrøm has received advisory board fees from Abbott and Novo Nordisk; and has received speakers fees from Novo Nordisk, Abbott, and Boston Scientific. Dr Clemmensen has received previous or current involvement in research contracts, consulting, or speaker bureau or received research and educational grants from Abbott, Abiomed, AliveCor Inc., AstraZeneca, Aventis, Bayer, Boehringer Ingelheim, Bristol Myers Squibb, CeleCor, Daiichi Sankyo, Eli-Lilly, Evolva, Fibrex, Idorsia, IQVIA, Janssen, Merck, Myogen, Medtronic, Mitsubishi Pharma, The Medicines Company, Nycomed, Organon, Pfizer, Pharmacia, Philips, Regado, Sanofi, Searle, Servier, and ViFor Pharma; and has received consultant fees, honoraria, and an educational grant from Abiomed J&J VP. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

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