FFR-guided complete revascularisation reduces long-term repeat cardiovascular events compared with infarct-related artery only treatment in patients with STEMI and multivessel disease, according to the 10-year results of the DANAMI-3-PRIMULTI trial presented at EuroPCR 2025.
The optimal long-term strategy for managing patients presenting with ST-segment elevation myocardial infarction (STEMI) and multivessel coronary artery disease remains a subject of ongoing debate. While complete revascularisation during the index hospitalisation has been shown to improve short-term outcomes, the durability and safety of this approach over a decade have not previously been established. The DANAMI-3-PRIMULTI trial was designed to address this question by comparing FFR-guided complete revascularisation to treatment of the infarct-related artery only, with a focus on all-cause mortality, recurrent myocardial infarction, and repeat revascularisation as the primary composite outcome.
A total of 627 patients with STEMI and at least one additional angiographically significant non-infarct-related lesion were randomised to either FFR-guided complete revascularisation (n=314) or infarct-related artery only treatment (n=313) following the initial PCI. Over 10 years of follow-up, the primary composite outcome occurred less frequently in the complete revascularisation group (hazard ratio 0.76, 95% CI 0.60–0.94, p=0.014), with event rates of 45% versus 54% in the infarct-related artery only group. This benefit was driven by a significant reduction in any repeat revascularisation (22% vs 31%, odds ratio 0.62, 95% CI 0.44–0.89), while there were no significant differences in all-cause mortality (24% vs 25%) or recurrent myocardial infarction (17% vs 19%). The mean cumulative number of events per 100 persons was 63 in the complete revascularisation group compared to 76 in the infarct-related artery only group, representing an absolute reduction of 13 events per 100 persons over a decade.
These findings confirm that FFR-guided complete revascularisation offers a sustained reduction in the need for future revascularisation procedures without increasing the risk of death or recurrent myocardial infarction. In clinical practice, this supports the use of physiology-guided complete revascularisation in STEMI patients with multivessel disease, particularly for those at higher risk of future events. Further research, including ongoing large-scale trials, will help clarify whether this approach can also improve survival or reduce myocardial infarction rates in broader patient populations. Clinicians should consider individual patient risk and anatomical complexity when planning revascularisation strategies, as tailored approaches may yield the greatest long-term benefit.
Reference
Engstrom T et al. Complete or culprit-only revascularisation in STEMI: 10-year outcome of DANAMI-3-PRIMULTI. EuroPCR 2025, 20-23 May, 2025.
