• Kasper Kyhl, Kiril Aleksov Ahtarovski, Lars Nepper-Christensen, Kathrine Ekström, Adam Ali Ghotbi, Mikkel Schoos, Christoffer Göransson, Litten Bertelsen, Steffen Helqvist, Lene Holmvang, Erik Jørgensen, Frants Pedersen, Kari Saunamäki, Peter Clemmensen, Ole De Backer, Dan Eik Høfsten, Lars Køber, Henning Kelbæk, Niels Vejlstrup, Jacob Lønborg, and Thomas Engstrøm.
• Department of Cardiology, Rigshospitalet, Copenhagen, Denmark. Electronic address: kasperkyhl@gmail.com.
• JACC Cardiovasc Interv. 2019 Apr 22; 12 (8): 721-730.

ObjectivesThe 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.BackgroundPatients 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.MethodsIn 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.ResultsA 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).ConclusionsComplete 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.Copyright © 2019 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

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