# Directe versus uitgestelde non-culprit PCI bij MI: gerandomiseerde trial

*geplaatst 2026-03-05 · Hartfalen · The New England journal of medicine · doi 10.1056/NEJMoa2512918 · https://hartvaat.nl/2026/03/05/directe-versus-uitgestelde-non-culprit-pci-bij-mi-gerandomiseerde-trial/*

Gerandomiseerde trial vergeleek directe met uitgestelde non-culprit PCI bij MI. De resultaten informeren de optimale timing van complete revascularisatie.

## English: Immediate or Deferred Nonculprit-Lesion PCI in Myocardial Infarction.

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.

## Abstract (original, from the publication)

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.).

Auteurs: 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

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Bron: The New England journal of medicine, https://doi.org/10.1056/NEJMoa2512918. Bijgewerkt 2026-07-03T13:31:11Z. 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.