09 Aug PCI Stenting All Lesions At Time of STEMI Reduces Reinfarction and Mortality
Medical Research: What is the background for this study? What are the main findings?
Dr. Kelbæk: The background to conduct the DANAMI 3-Primulti trial is the uncertainty of which strategy is most favourable to the patient with ST-segment elevation myocardial infarction: to treat the culprit (resposible for the acute infarction) lesion only or to treat all visible lesions (complete revascularisation)
The main findings of the PRIMULTI trial are that patients with ST-segment elevation myocardial infarction and multivessel disease, benefit from supplementary complete revascularisation of lesions in non-infarct related arteries when the second procedure is done during the index admission guided by measurement of the fractional flow reserve. This strategy results in a significant reduction in the combination of all-cause mortality, nonfatal reinfarction, and ischaemia-driven revascularisation.
Medical Research: What should clinicians and patients take away from your report?
Dr. Kelbæk: The take home message is that PCI of all lesions is safe when performed within the index admission. However, the effect of this staged strategy is driven entirely by the need for repeat revascularisation.
Medical Research: What recommendations do you have for future research as a result of this study?
Dr. Kelbæk: Several remaining questions have to be answered:
- Will complete revascularisation turn out to reduce mortality and/or the occurrence of reinfarction in a sufficiently powered (larger) trial ?
- Should only non-culprit lesions with prognostic significance be selected for treatment (in addition to the culprit lesion), and if so which lesions should be selected ? Is measurement of the fractional flow reserve necessary ?
- Should complete revascularisation be performed immediately, 2 days later or remote from the acute ST-segment elevation myocardial infarction ?
Complete revascularisation versus treatment of the culprit lesion only in patients with ST-segment elevation myocardial infarction and multivessel disease (DANAMI-3—PRIMULTI): an open-label, randomised controlled trial
Thomas Engstrøm, MD Dr Henning Kelbæk, MD et al for the DANAMI-3—PRIMULTI Investigators
The Lancet: Published Online: 04 August 2015
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Henning Kelbæk, MD (2015). PCI Stenting All Lesions At Time of STEMI Reduces Reinfarction and Mortality