Fractional Flow Reserve-Guided Complete Revascularization Improves the Prognosis in Patients With ST-Segment-Elevation Myocardial Infarction and Severe Nonculprit Disease: A DANAMI 3-PRIMULTI Substudy (Primary PCI in Patients With ST-Elevation Myocardial Infarction and Multivessel Disease: Treatment of Culprit Lesion Only or Complete Revascularization)

Jacob Lønborg; Thomas Engstrøm; Henning Kelbæk; Steffen Helqvist; Lene Kløvgaard; Lene Holmvang; Frants Pedersen; Erik Jørgensen; Kari Saunamäki; Peter Clemmensen; Ole De Backer; Jan Ravkilde; Hans-Henrik Tilsted; Anton Boel Villadsen; Jens Aarøe; Svend Eggert Jensen; Bent Raungaard; Lars Køber; Dan Eik Høfsten; DANAMI 3-PRIMULTI Investigators

doi:10.1161/CIRCINTERVENTIONS.116.004460

Fractional Flow Reserve-Guided Complete Revascularization Improves the Prognosis in Patients With ST-Segment-Elevation Myocardial Infarction and Severe Nonculprit Disease: A DANAMI 3-PRIMULTI Substudy (Primary PCI in Patients With ST-Elevation Myocardial Infarction and Multivessel Disease: Treatment of Culprit Lesion Only or Complete Revascularization)

Jacob Lønborg, Thomas Engstrøm, Henning Kelbæk, Steffen Helqvist, Lene Kløvgaard, Lene Holmvang, Frants Pedersen, Erik Jørgensen, Kari Saunamäki, Peter Clemmensen, Ole De Backer, Jan Ravkilde, Hans-Henrik Tilsted, Anton Boel Villadsen, Jens Aarøe, Svend Eggert Jensen, Bent Raungaard, Lars Køber, Dan Eik Høfsten, DANAMI 3-PRIMULTI Investigators

Department of Clinical Medicine

25 Citations (Scopus)

Abstract

BACKGROUND: The impact of disease severity on the outcome after complete revascularization in patients with ST-segment-elevation myocardial infarction and multivessel disease is uncertain. The objective of this post hoc study was to evaluate the impact of number of diseased vessel, lesion location, and severity of the noninfarct-related stenosis on the effect of fractional flow reserve-guided complete revascularization.

METHODS AND RESULTS: In the DANAMI-3-PRIMULTI study (Primary PCI in Patients With ST-Elevation Myocardial Infarction and Multivessel Disease: Treatment of Culprit Lesion Only or Complete Revascularization), we randomized 627 ST-segment-elevation myocardial infarction patients to fractional flow reserve-guided complete revascularization or infarct-related percutaneous coronary intervention only. In patients with 3-vessel disease, fractional flow reserve-guided complete revascularization reduced the primary end point (all-cause mortality, reinfarction, and ischemia-driven revascularization; hazard ratio [HR], 0.33; 95% confidence interval [CI], 0.17-0.64; P=0.001), with no significant effect in patients with 2-vessel disease (HR, 0.77; 95% CI, 0.47-1.26; P=0.29; P for interaction =0.046). A similar effect was observed in patients with diameter stenosis ≥90% of noninfarct-related arteries (HR, 0.32; 95% CI, 0.18-0.62; P=0.001), but not in patients with less severe lesions (HR, 0.72; 95% CI, 0.44-1.19; P=0.21; P for interaction =0.06). The effect was most pronounced in patients with 3-vessel disease and noninfarct-related stenoses ≥90%, and in this subgroup, there was a nonsignificant reduction in the end point of mortality and reinfarction (HR, 0.32; 95% CI, 0.08-1.32; P=0.09). Proximal versus distal location did not influence the benefit from complete revascularization.

CONCLUSIONS: The benefit from fractional flow reserve-guided complete revascularization in ST-segment-elevation myocardial infarction patients with multivessel disease was dependent on the presence of 3-vessel disease and noninfarct diameter stenosis ≥90% and was particularly pronounced in patients with both of these angiographic characteristics.

CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01960933.

Original language	English
Article number	e004460
Journal	Circulation: Cardiovascular Interventions
Volume	10
Issue number	4
Number of pages	27
ISSN	1941-7640
DOIs	https://doi.org/10.1161/CIRCINTERVENTIONS.116.004460
Publication status	Published - Apr 2017

Keywords

Adult
Aged
Aged, 80 and over
Coronary Angiography
Coronary Artery Disease/diagnosis
Coronary Vessels/diagnostic imaging
Electrocardiography
Female
Follow-Up Studies
Fractional Flow Reserve, Myocardial/physiology
Humans
Male
Middle Aged
Myocardial Revascularization/methods
Percutaneous Coronary Intervention/methods
Prognosis
Recovery of Function/physiology
Retrospective Studies
ST Elevation Myocardial Infarction/diagnosis
Severity of Illness Index
Time Factors
Treatment Outcome

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Lønborg, J., Engstrøm, T., Kelbæk, H., Helqvist, S., Kløvgaard, L., Holmvang, L., Pedersen, F., Jørgensen, E., Saunamäki, K., Clemmensen, P., De Backer, O., Ravkilde, J., Tilsted, H.-H., Villadsen, A. B., Aarøe, J., Jensen, S. E., Raungaard, B., Køber, L., Høfsten, D. E., & DANAMI 3-PRIMULTI Investigators (2017). Fractional Flow Reserve-Guided Complete Revascularization Improves the Prognosis in Patients With ST-Segment-Elevation Myocardial Infarction and Severe Nonculprit Disease: A DANAMI 3-PRIMULTI Substudy (Primary PCI in Patients With ST-Elevation Myocardial Infarction and Multivessel Disease: Treatment of Culprit Lesion Only or Complete Revascularization). Circulation: Cardiovascular Interventions, 10(4), Article e004460. https://doi.org/10.1161/CIRCINTERVENTIONS.116.004460

Fractional Flow Reserve-Guided Complete Revascularization Improves the Prognosis in Patients With ST-Segment-Elevation Myocardial Infarction and Severe Nonculprit Disease: A DANAMI 3-PRIMULTI Substudy (Primary PCI in Patients With ST-Elevation Myocardial Infarction and Multivessel Disease: Treatment of Culprit Lesion Only or Complete Revascularization). / Lønborg, Jacob; Engstrøm, Thomas; Kelbæk, Henning et al.
In: Circulation: Cardiovascular Interventions, Vol. 10, No. 4, e004460, 04.2017.

Research output: Contribution to journal › Journal article › Research › peer-review

Lønborg, J, Engstrøm, T, Kelbæk, H, Helqvist, S, Kløvgaard, L, Holmvang, L, Pedersen, F, Jørgensen, E, Saunamäki, K, Clemmensen, P, De Backer, O, Ravkilde, J, Tilsted, H-H, Villadsen, AB, Aarøe, J, Jensen, SE, Raungaard, B, Køber, L, Høfsten, DE & DANAMI 3-PRIMULTI Investigators 2017, 'Fractional Flow Reserve-Guided Complete Revascularization Improves the Prognosis in Patients With ST-Segment-Elevation Myocardial Infarction and Severe Nonculprit Disease: A DANAMI 3-PRIMULTI Substudy (Primary PCI in Patients With ST-Elevation Myocardial Infarction and Multivessel Disease: Treatment of Culprit Lesion Only or Complete Revascularization)', Circulation: Cardiovascular Interventions, vol. 10, no. 4, e004460. https://doi.org/10.1161/CIRCINTERVENTIONS.116.004460

Lønborg J, Engstrøm T, Kelbæk H, Helqvist S, Kløvgaard L, Holmvang L et al. Fractional Flow Reserve-Guided Complete Revascularization Improves the Prognosis in Patients With ST-Segment-Elevation Myocardial Infarction and Severe Nonculprit Disease: A DANAMI 3-PRIMULTI Substudy (Primary PCI in Patients With ST-Elevation Myocardial Infarction and Multivessel Disease: Treatment of Culprit Lesion Only or Complete Revascularization). Circulation: Cardiovascular Interventions. 2017 Apr;10(4):e004460. doi: 10.1161/CIRCINTERVENTIONS.116.004460

Lønborg, Jacob ; Engstrøm, Thomas ; Kelbæk, Henning et al. / Fractional Flow Reserve-Guided Complete Revascularization Improves the Prognosis in Patients With ST-Segment-Elevation Myocardial Infarction and Severe Nonculprit Disease : A DANAMI 3-PRIMULTI Substudy (Primary PCI in Patients With ST-Elevation Myocardial Infarction and Multivessel Disease: Treatment of Culprit Lesion Only or Complete Revascularization). In: Circulation: Cardiovascular Interventions. 2017 ; Vol. 10, No. 4.

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title = "Fractional Flow Reserve-Guided Complete Revascularization Improves the Prognosis in Patients With ST-Segment-Elevation Myocardial Infarction and Severe Nonculprit Disease: A DANAMI 3-PRIMULTI Substudy (Primary PCI in Patients With ST-Elevation Myocardial Infarction and Multivessel Disease: Treatment of Culprit Lesion Only or Complete Revascularization)",

abstract = "BACKGROUND: The impact of disease severity on the outcome after complete revascularization in patients with ST-segment-elevation myocardial infarction and multivessel disease is uncertain. The objective of this post hoc study was to evaluate the impact of number of diseased vessel, lesion location, and severity of the noninfarct-related stenosis on the effect of fractional flow reserve-guided complete revascularization.METHODS AND RESULTS: In the DANAMI-3-PRIMULTI study (Primary PCI in Patients With ST-Elevation Myocardial Infarction and Multivessel Disease: Treatment of Culprit Lesion Only or Complete Revascularization), we randomized 627 ST-segment-elevation myocardial infarction patients to fractional flow reserve-guided complete revascularization or infarct-related percutaneous coronary intervention only. In patients with 3-vessel disease, fractional flow reserve-guided complete revascularization reduced the primary end point (all-cause mortality, reinfarction, and ischemia-driven revascularization; hazard ratio [HR], 0.33; 95% confidence interval [CI], 0.17-0.64; P=0.001), with no significant effect in patients with 2-vessel disease (HR, 0.77; 95% CI, 0.47-1.26; P=0.29; P for interaction =0.046). A similar effect was observed in patients with diameter stenosis ≥90% of noninfarct-related arteries (HR, 0.32; 95% CI, 0.18-0.62; P=0.001), but not in patients with less severe lesions (HR, 0.72; 95% CI, 0.44-1.19; P=0.21; P for interaction =0.06). The effect was most pronounced in patients with 3-vessel disease and noninfarct-related stenoses ≥90%, and in this subgroup, there was a nonsignificant reduction in the end point of mortality and reinfarction (HR, 0.32; 95% CI, 0.08-1.32; P=0.09). Proximal versus distal location did not influence the benefit from complete revascularization.CONCLUSIONS: The benefit from fractional flow reserve-guided complete revascularization in ST-segment-elevation myocardial infarction patients with multivessel disease was dependent on the presence of 3-vessel disease and noninfarct diameter stenosis ≥90% and was particularly pronounced in patients with both of these angiographic characteristics.CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01960933.",

keywords = "Adult, Aged, Aged, 80 and over, Coronary Angiography, Coronary Artery Disease/diagnosis, Coronary Vessels/diagnostic imaging, Electrocardiography, Female, Follow-Up Studies, Fractional Flow Reserve, Myocardial/physiology, Humans, Male, Middle Aged, Myocardial Revascularization/methods, Percutaneous Coronary Intervention/methods, Prognosis, Recovery of Function/physiology, Retrospective Studies, ST Elevation Myocardial Infarction/diagnosis, Severity of Illness Index, Time Factors, Treatment Outcome",

author = "Jacob L{\o}nborg and Thomas Engstr{\o}m and Henning Kelb{\ae}k and Steffen Helqvist and Lene Kl{\o}vgaard and Lene Holmvang and Frants Pedersen and Erik J{\o}rgensen and Kari Saunam{\"a}ki and Peter Clemmensen and {De Backer}, Ole and Jan Ravkilde and Hans-Henrik Tilsted and Villadsen, {Anton Boel} and Jens Aar{\o}e and Jensen, {Svend Eggert} and Bent Raungaard and Lars K{\o}ber and H{\o}fsten, {Dan Eik} and {DANAMI 3-PRIMULTI Investigators}",

note = "{\textcopyright} 2017 American Heart Association, Inc.",

year = "2017",

month = apr,

doi = "10.1161/CIRCINTERVENTIONS.116.004460",

language = "English",

volume = "10",

journal = "Circulation: Cardiovascular Interventions",

issn = "1941-7640",

publisher = "Lippincott Williams & Wilkins",

number = "4",

}

TY - JOUR

T1 - Fractional Flow Reserve-Guided Complete Revascularization Improves the Prognosis in Patients With ST-Segment-Elevation Myocardial Infarction and Severe Nonculprit Disease

T2 - A DANAMI 3-PRIMULTI Substudy (Primary PCI in Patients With ST-Elevation Myocardial Infarction and Multivessel Disease: Treatment of Culprit Lesion Only or Complete Revascularization)

AU - Lønborg, Jacob

AU - Engstrøm, Thomas

AU - Kelbæk, Henning

AU - Helqvist, Steffen

AU - Kløvgaard, Lene

AU - Holmvang, Lene

AU - Pedersen, Frants

AU - Jørgensen, Erik

AU - Saunamäki, Kari

AU - Clemmensen, Peter

AU - De Backer, Ole

AU - Ravkilde, Jan

AU - Tilsted, Hans-Henrik

AU - Villadsen, Anton Boel

AU - Aarøe, Jens

AU - Jensen, Svend Eggert

AU - Raungaard, Bent

AU - Køber, Lars

AU - Høfsten, Dan Eik

AU - DANAMI 3-PRIMULTI Investigators

PY - 2017/4

Y1 - 2017/4

N2 - BACKGROUND: The impact of disease severity on the outcome after complete revascularization in patients with ST-segment-elevation myocardial infarction and multivessel disease is uncertain. The objective of this post hoc study was to evaluate the impact of number of diseased vessel, lesion location, and severity of the noninfarct-related stenosis on the effect of fractional flow reserve-guided complete revascularization.METHODS AND RESULTS: In the DANAMI-3-PRIMULTI study (Primary PCI in Patients With ST-Elevation Myocardial Infarction and Multivessel Disease: Treatment of Culprit Lesion Only or Complete Revascularization), we randomized 627 ST-segment-elevation myocardial infarction patients to fractional flow reserve-guided complete revascularization or infarct-related percutaneous coronary intervention only. In patients with 3-vessel disease, fractional flow reserve-guided complete revascularization reduced the primary end point (all-cause mortality, reinfarction, and ischemia-driven revascularization; hazard ratio [HR], 0.33; 95% confidence interval [CI], 0.17-0.64; P=0.001), with no significant effect in patients with 2-vessel disease (HR, 0.77; 95% CI, 0.47-1.26; P=0.29; P for interaction =0.046). A similar effect was observed in patients with diameter stenosis ≥90% of noninfarct-related arteries (HR, 0.32; 95% CI, 0.18-0.62; P=0.001), but not in patients with less severe lesions (HR, 0.72; 95% CI, 0.44-1.19; P=0.21; P for interaction =0.06). The effect was most pronounced in patients with 3-vessel disease and noninfarct-related stenoses ≥90%, and in this subgroup, there was a nonsignificant reduction in the end point of mortality and reinfarction (HR, 0.32; 95% CI, 0.08-1.32; P=0.09). Proximal versus distal location did not influence the benefit from complete revascularization.CONCLUSIONS: The benefit from fractional flow reserve-guided complete revascularization in ST-segment-elevation myocardial infarction patients with multivessel disease was dependent on the presence of 3-vessel disease and noninfarct diameter stenosis ≥90% and was particularly pronounced in patients with both of these angiographic characteristics.CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01960933.

AB - BACKGROUND: The impact of disease severity on the outcome after complete revascularization in patients with ST-segment-elevation myocardial infarction and multivessel disease is uncertain. The objective of this post hoc study was to evaluate the impact of number of diseased vessel, lesion location, and severity of the noninfarct-related stenosis on the effect of fractional flow reserve-guided complete revascularization.METHODS AND RESULTS: In the DANAMI-3-PRIMULTI study (Primary PCI in Patients With ST-Elevation Myocardial Infarction and Multivessel Disease: Treatment of Culprit Lesion Only or Complete Revascularization), we randomized 627 ST-segment-elevation myocardial infarction patients to fractional flow reserve-guided complete revascularization or infarct-related percutaneous coronary intervention only. In patients with 3-vessel disease, fractional flow reserve-guided complete revascularization reduced the primary end point (all-cause mortality, reinfarction, and ischemia-driven revascularization; hazard ratio [HR], 0.33; 95% confidence interval [CI], 0.17-0.64; P=0.001), with no significant effect in patients with 2-vessel disease (HR, 0.77; 95% CI, 0.47-1.26; P=0.29; P for interaction =0.046). A similar effect was observed in patients with diameter stenosis ≥90% of noninfarct-related arteries (HR, 0.32; 95% CI, 0.18-0.62; P=0.001), but not in patients with less severe lesions (HR, 0.72; 95% CI, 0.44-1.19; P=0.21; P for interaction =0.06). The effect was most pronounced in patients with 3-vessel disease and noninfarct-related stenoses ≥90%, and in this subgroup, there was a nonsignificant reduction in the end point of mortality and reinfarction (HR, 0.32; 95% CI, 0.08-1.32; P=0.09). Proximal versus distal location did not influence the benefit from complete revascularization.CONCLUSIONS: The benefit from fractional flow reserve-guided complete revascularization in ST-segment-elevation myocardial infarction patients with multivessel disease was dependent on the presence of 3-vessel disease and noninfarct diameter stenosis ≥90% and was particularly pronounced in patients with both of these angiographic characteristics.CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01960933.

KW - Adult

KW - Aged

KW - Aged, 80 and over

KW - Coronary Angiography

KW - Coronary Artery Disease/diagnosis

KW - Coronary Vessels/diagnostic imaging

KW - Electrocardiography

KW - Female

KW - Follow-Up Studies

KW - Fractional Flow Reserve, Myocardial/physiology

KW - Humans

KW - Male

KW - Middle Aged

KW - Myocardial Revascularization/methods

KW - Percutaneous Coronary Intervention/methods

KW - Prognosis

KW - Recovery of Function/physiology

KW - Retrospective Studies

KW - ST Elevation Myocardial Infarction/diagnosis

KW - Severity of Illness Index

KW - Time Factors

KW - Treatment Outcome

U2 - 10.1161/CIRCINTERVENTIONS.116.004460

DO - 10.1161/CIRCINTERVENTIONS.116.004460

M3 - Journal article

C2 - 28404623

SN - 1941-7640

VL - 10

JO - Circulation: Cardiovascular Interventions

JF - Circulation: Cardiovascular Interventions

IS - 4

M1 - e004460

ER -