{"id":"60cf9fd49d3f","type":"article","url":"https://hartvaat.nl/2026/03/05/directe-versus-uitgestelde-non-culprit-pci-bij-mi-gerandomiseerde-trial/","title":"Directe versus uitgestelde non-culprit PCI bij MI: gerandomiseerde trial","title_en":"Immediate or Deferred Nonculprit-Lesion PCI in Myocardial Infarction.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["percutane-coronaire-interventie"],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa2512918","source_url":"https://doi.org/10.1056/NEJMoa2512918","authors":["Robin Nijveldt","Michael Maeng","Casper W H Beijnink","Jan J Piek","Rasha K Al-Lamee","Luís Raposo","Sergio Bravo Baptista","Javier Escaned","Justin Davies","Igor Klem","Bahram Yosofi","Robert-Jan M van Geuns","Christian A Frederiksen","Lars Jakobsen","Abdelilah El Barzouhi","Dirk J van der Heijden","Mustafa Ilhan","Saman Rasoul","Stijn Brinckman","Colette Saraber","Daniel A Jones","Steffen E Petersen","Tomaž Podlesnikar","Matjaž Bunc","Marcel A M Beijk","Lieuwe H Piers","Johannes B van Rees","Henry Seligman","Graham Cole","Juan F Iglesias","Sophie Degrauwe","Arnoud W J van 't Hof","Erik Lipsic","Gabija Pundziute-do Prado","Pairoj Chattranukulchai","José F Rodríguez-Palomares","Johannes Rigger","Martijn Meuwissen","Lennaert Kleijn","Bruno Pereira","Lorenzo Monti","René J van der Schaaf","Juan Sanchis","Guido Belli","Jan G P Tijssen","Troels Thim","Niels van Royen"],"significance":7,"published":"2026-03-05","source_date":"2026-03-05","image":"","kennis":[],"congress":"","summary_en":"This NEJM trial compared immediate with deferred nonculprit-lesion PCI in STEMI, addressing the optimal timing of complete revascularization in the acute MI setting with contemporary evidence.","created":"2026-07-03T10:32:13Z","updated":"2026-07-03T13:31:11Z","licence":"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.","body_markdown":"Gerandomiseerde trial vergeleek directe met uitgestelde non-culprit PCI bij MI. De resultaten informeren de optimale timing van complete revascularisatie.","abstract_original":"BACKGROUND: The preferred timing of treatment of nonculprit lesions in patients with ST-segment elevation myocardial infarction (STEMI) remains uncertain. A comparison of immediate percutaneous coronary intervention (PCI) guided by instantaneous wave-free ratio (iFR) and deferred PCI guided by cardiac stress magnetic resonance imaging (MRI) in patients with STEMI and multivessel disease is warranted. METHODS: In this international, investigator-initiated, open-label, randomized, controlled trial, patients with STEMI and at least one nonculprit lesion who had undergone successful primary PCI were randomly assigned in a 1:1 ratio to immediate iFR-guided PCI (in lesions with >50% stenosis and an iFR of ≤0.89 [normal value, >0.89]) or deferred cardiac stress MRI-guided PCI within 6 weeks after randomization. The primary end point was a composite of death from any cause, recurrent myocardial infarction, or hospitalization for heart failure at 3-year follow-up. RESULTS: The trial included 1146 patients (558 in the iFR group and 588 in the MRI group) with a mean (±SD) age of 63±11 years; 78% were men. A total of 237 of 556 patients (42.6%) in the iFR group and 110 of 587 patients (18.7%) in the MRI group underwent nonculprit-lesion coronary-artery PCI. A primary-end-point event occurred in 50 patients (9.3%) in the iFR group and in 55 patients (9.8%) in the MRI group (hazard ratio, 0.95; 95% confidence interval, 0.65 to 1.40; P = 0.81). Serious adverse events occurred in 145 patients in the iFR group and in 181 in the MRI group. CONCLUSIONS: Among patients with STEMI who have undergone successful primary PCI, immediate iFR-guided PCI was not superior to deferred cardiac stress MRI-guided PCI of nonculprit coronary-artery lesions with respect to death from any cause, recurrent myocardial infarction, or hospitalization for heart failure at 3 years. (Funded by Philips Volcano and others; iMODERN ClinicalTrials.gov number, NCT03298659.)."}