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

Ole De Backer, Jacob Lønborg, Steffen Helqvist, Julie Warnøe, Lene Kløvgaard, Lene Holmvang, Frants Pedersen, Hans-Henrik Tilsted, Bent Raungaard, Erik Jørgensen, Lars Køber, Dan Eik Høfsten, Henning Kelbæk, Thomas Engstrøm

Research output: Contribution to journalJournal articleResearchpeer-review

Abstract

AIMS: 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.

METHODS AND RESULTS: 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<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 - in particular, ≥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 ≤0.80 was shown to be an appropriate threshold for revascularisation.

CONCLUSIONS: 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.

Original languageEnglish
JournalEuroIntervention
Volume15
Issue number2
Pages (from-to)172-179
Number of pages8
ISSN1774-024X
DOIs
Publication statusPublished - Jun 2019

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Ischemia
Myocardial Infarction
Pathologic Constriction
Arteries
Unstable Angina
Coronary Vessels
Therapeutics

Cite this

De Backer, Ole ; Lønborg, Jacob ; Helqvist, Steffen ; Warnøe, Julie ; Kløvgaard, Lene ; Holmvang, Lene ; Pedersen, Frants ; Tilsted, Hans-Henrik ; Raungaard, Bent ; Jørgensen, Erik ; Køber, Lars ; Høfsten, Dan Eik ; Kelbæk, Henning ; Engstrøm, Thomas. / 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. In: EuroIntervention. 2019 ; Vol. 15, No. 2. pp. 172-179.
@article{8ad469bda9c74d13ba10d8fff7fadf4e,
title = "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",
abstract = "AIMS: 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.METHODS AND RESULTS: 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<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 - in particular, ≥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 ≤0.80 was shown to be an appropriate threshold for revascularisation.CONCLUSIONS: 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.",
author = "{De Backer}, Ole and Jacob L{\o}nborg and Steffen Helqvist and Julie Warn{\o}e and Lene Kl{\o}vgaard and Lene Holmvang and Frants Pedersen and Hans-Henrik Tilsted and Bent Raungaard and Erik J{\o}rgensen and Lars K{\o}ber and H{\o}fsten, {Dan Eik} and Henning Kelb{\ae}k and Thomas Engstr{\o}m",
year = "2019",
month = "6",
doi = "10.4244/EIJ-D-18-00766",
language = "English",
volume = "15",
pages = "172--179",
journal = "EuroIntervention",
issn = "1774-024X",
publisher = "Europa Digital & Publishing",
number = "2",

}

De Backer, O, Lønborg, J, Helqvist, S, Warnøe, J, Kløvgaard, L, Holmvang, L, Pedersen, F, Tilsted, H-H, Raungaard, B, Jørgensen, E, Køber, L, Høfsten, DE, Kelbæk, H & Engstrøm, T 2019, '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', EuroIntervention, vol. 15, no. 2, pp. 172-179. https://doi.org/10.4244/EIJ-D-18-00766

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. / De Backer, Ole; Lønborg, Jacob; Helqvist, Steffen; Warnøe, Julie; Kløvgaard, Lene; Holmvang, Lene; Pedersen, Frants; Tilsted, Hans-Henrik; Raungaard, Bent; Jørgensen, Erik; Køber, Lars; Høfsten, Dan Eik; Kelbæk, Henning; Engstrøm, Thomas.

In: EuroIntervention, Vol. 15, No. 2, 06.2019, p. 172-179.

Research output: Contribution to journalJournal articleResearchpeer-review

TY - JOUR

T1 - Characterisation of lesions undergoing ischaemia-driven revascularisation after complete revascularisation versus culprit lesion only in patients with STEMI and multivessel disease

T2 - a DANAMI-3-PRIMULTI substudy

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, Dan Eik

AU - Kelbæk, Henning

AU - Engstrøm, Thomas

PY - 2019/6

Y1 - 2019/6

N2 - AIMS: 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.METHODS AND RESULTS: 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<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 - in particular, ≥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 ≤0.80 was shown to be an appropriate threshold for revascularisation.CONCLUSIONS: 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.

AB - AIMS: 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.METHODS AND RESULTS: 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<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 - in particular, ≥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 ≤0.80 was shown to be an appropriate threshold for revascularisation.CONCLUSIONS: 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.

U2 - 10.4244/EIJ-D-18-00766

DO - 10.4244/EIJ-D-18-00766

M3 - Journal article

C2 - 30666962

VL - 15

SP - 172

EP - 179

JO - EuroIntervention

JF - EuroIntervention

SN - 1774-024X

IS - 2

ER -