# Complete versus culprit-only revascularisatie bij STEMI: tienjaarsresultaten

*geplaatst 2025-07-15 · Algemeen · Journal of the American College of Cardiology · doi 10.1016/j.jacc.2025.05.013 · https://hartvaat.nl/2025/07/15/complete-versus-culprit-only-revascularisatie-bij-stemi-tienjaarsresultaten/*

Tienjaarsresultaten bevestigden het duurzame voordeel van complete revascularisatie bij STEMI met meervatslijden. Het overlevingsvoordeel bleef behouden over een decennium, wat complete revascularisatie als standaard definitief ondersteunt.

## English: 10-Year Outcome of Complete or Infarct Artery-Only Revascularization in STEMI With Multivessel Disease: The DANAMI-3-PRIMULTI Study.

Ten-year DANAMI-3-PRIMULTI results confirmed the durable benefit of complete revascularization over culprit-only PCI in patients with STEMI and multivessel disease. The survival advantage persisted over a decade of follow-up.

## Abstract (original, from the publication)

BACKGROUND: The long-term outcomes of complete revascularization in ST-segment elevation myocardial infarction (STEMI) and multivessel disease is unknown. OBJECTIVES: The purpose of this study was to investigate the 10-year clinical outcomes including repeated events of fractional flow reserve (FFR)-guided complete revascularization vs treatment of the infarct-related artery only in STEMI. METHODS: This 10-year follow-up study of DANAMI-3-PRIMULTI (Third DANish Study of Optimal Acute Treatment of Patients With STEMI-Complete Revascularization versus Infarct-Related Artery Only) included patients with STEMI and ≥1 angiographically significant non-infarct-related lesion, randomized to FFR-guided complete revascularization or infarct-related artery only after the index procedure. As the original trial, the primary outcome was a composite of all-cause mortality, recurrent myocardial infarction, or any revascularization. Repeated events of revascularization and myocardial infarction were analyzed. RESULTS: Of 627 included patients, 313 were randomized to infarct-related artery only and 314 to complete revascularization. After 10 years, complete revascularization reduced the risk of the primary outcome (HR: 0.76; 95% CI: 0.60-0.94; P = 0.014). In the infarct-related artery-only group, 78 (25%) died vs 74 (24%) in the complete revascularization group. Complete revascularization reduced any revascularization compared with infarct-related artery only (OR: 0.62; 95% CI: 0.44-0.89). There was no difference in recurrent myocardial infarction (OR: 0.90; 95% CI: 0.60-1.35). The mean cumulative number of events were 76 per 100 persons (95% CI: 66-88) in the infarct-related artery-only group vs 63 events per 100 persons (95% CI: 54-73) in the complete revascularization group (absolute reduction: 13%; 95% CI: -1% to 28%). CONCLUSIONS: FFR-guided complete revascularization reduced future and repeated events compared with infarct-related artery only after 10 years. The risk was mainly driven by revascularization, with no reduction in myocardial infarctions or death. (Primary PCI in Patients With ST-elevation Myocardial Infarction and Multivessel Disease: Treatment of Culprit Lesion Only or Complete Revascularization [PRIMULTI]; NCT01960933).

Auteurs: Jasmine M Marquard, Rasmus P Beske, Henning Kelbæk, Lene Holmvang, Frants Pedersen, Peter Clemmensen, Ole De Backer, Bent Raungaard, Ashkan Eftekhari, Utsho Islam, Lars Køber, Hans-Henrik Tilsted, Charlotte Glinge, Reza Jabbari, Thomas Scheike, Dan E Høfsten, Jacob T Lønborg, Thomas Engstrøm

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Bron: Journal of the American College of Cardiology, https://doi.org/10.1016/j.jacc.2025.05.013. Bijgewerkt 2026-07-03T13:30:44Z. Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.