Author + information
- Received October 1, 2018
- Revision received January 25, 2019
- Accepted January 29, 2019
- Published online April 15, 2019.
- Kasper Kyhl, MD, PhDa,∗ (, )
- Kiril Aleksov Ahtarovski, MD, PhDa,
- Lars Nepper-Christensen, MD, PhDa,
- Kathrine Ekström, MDa,
- Adam Ali Ghotbi, MD, PhDa,
- Mikkel Schoos, MD, PhDa,
- Christoffer Göransson, MDa,
- Litten Bertelsen, MDa,
- Steffen Helqvist, MD, DMSca,
- Lene Holmvang, MD, DMSca,
- Erik Jørgensen, MDa,
- Frants Pedersen, MD, PhDa,
- Kari Saunamäki, MD, DMSca,
- Peter Clemmensen, MD, PhD, DMScb,c,
- Ole De Backer, MD, PhDa,
- Dan Eik Høfsten, MD, PhDa,
- Lars Køber, MD, DMSca,
- Henning Kelbæk, MD, DMScd,
- Niels Vejlstrup, MD, PhDd,
- Jacob Lønborg, MD, PhD, DMScd and
- Thomas Engstrøm, MD, PhD, DMSca,e
- aDepartment of Cardiology, Rigshospitalet, Copenhagen, Denmark
- bDepartment of Medicine, Nykoebing F Hospital, Nykoebing F and University of Southern Denmark, Odense, Denmark
- cUniversity Clinic of Hamburg-Eppendorf, The Heart Centre, Hamburg, Germany
- dDepartment of Cardiology, Zealand University, Roskilde, Denmark
- eDepartment of Cardiology, University of Lund, Lund, Sweden
- ↵∗Address for correspondence:
Dr. Kasper Kyhl, Department of Cardiology, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark.
Objectives The aim of this study was to evaluate the effect of fractional flow reserve (FFR)–guided revascularization compared with culprit-only percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI) on infarct size, left ventricular (LV), function, LV remodeling, and the presence of nonculprit infarctions.
Background Patients with STEMI with multivessel disease might have improved clinical outcomes after complete revascularization compared with PCI of the infarct-related artery only, but the impact on infarct size, LV function, and remodeling as well as the risk for periprocedural infarction are unknown.
Methods In this substudy of the DANAMI-3 (Third Danish Trial in Acute Myocardial Infarction)–PRIMULTI (Primary PCI in Patients With ST-Elevation Myocardial Infarction and Multivessel Disease: Treatment of Culprit Lesion Only or Complete Revascularization) randomized trial, patients with STEMI with multivessel disease were randomized to receive either complete FFR-guided revascularization or PCI of the culprit vessel only. The patients underwent cardiac magnetic resonance imaging during index admission and at 3-month follow-up.
Results A total of 280 patients (136 patients with infarct-related and 144 with complete FFR-guided revascularization) were included. There were no differences in final infarct size (median 12% [interquartile range: 5% to 19%] vs. 11% [interquartile range: 4% to 18%]; p = 0.62), myocardial salvage index (median 0.71 [interquartile range: 0.54 to 0.89] vs. 0.66 [interquartile range: 0.55 to 0.87]; p = 0.49), LV ejection fraction (mean 58 ± 9% vs. 59 ± 9%; p = 0.39), and LV end-systolic volume remodeling (mean 7 ± 22 ml vs. 7 ± 19 ml; p = 0.63). New nonculprit infarction occurring after the nonculprit intervention was numerically more frequent among patients treated with complete revascularization (6 [4.5%] vs. 1 [0.8%]; p = 0.12).
Conclusions Complete FFR-guided revascularization in patients with STEMI and multivessel disease did not affect final infarct size, LV function, or remodeling compared with culprit-only PCI.
- acute myocardial infarction
- cardiac function
- cardiac remodeling
- cardiovascular magnetic resonance
- complete revascularization
- culprit lesion
- primary percutaneous coronary intervention
- randomized study
- ST-segment elevation myocardial infarction
The Research Foundation of the Department of Cardiology, Rigshospitalet, the Danish Heart Foundation, and the Danish Agency for Science, Technology and Innovation by the Danish Council for Strategic Research supported this study (Eastern Denmark Initiative to Improve Revascularization Strategies grant 09-066994). Dr. Lønborg has received fees from St. Jude Medical. Dr. Køber has received grants from the Danish Research Foundation. Dr. Engstrøm has received fees from St. Jude Medical, Bayer, Boston Scientific, and AstraZeneca. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received October 1, 2018.
- Revision received January 25, 2019.
- Accepted January 29, 2019.
- 2019 American College of Cardiology Foundation
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