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FFR-Guided PCI Deferral in STEMI Multivessel Disease Linked to Worse Long-Term OutcomesTreating multiple heart blockages may lower risk of death

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Key Takeaway
Deferring PCI of non-culprit lesions with FFR > 0.80 in STEMI multivessel disease was linked to higher long-term cardiovascular risk.

This randomized controlled trial substudy examined long-term outcomes of deferring PCI for non-culprit lesions in patients with ST-segment elevation myocardial infarction (STEMI) and multivessel disease. The analysis included 280 patients from the DANAMI-3 PRIMULTI trial, with a median follow-up of 10.5 years.

Patients were assigned to either PCI-deferral (no PCI of non-culprit lesions with FFR > 0.80) or a PCI group (treatment of at least one non-culprit lesion with FFR ≤ 0.80 or angiographic diameter stenosis ≥ 90%). The primary combined endpoint was all-cause mortality, myocardial infarction, or urgent revascularization.

The combined endpoint occurred in 36% of the PCI group versus 47% of the PCI-deferral group (adjusted HR 0.64, 95% CI 0.44-0.95, p = 0.025), with 62 and 50 events respectively. Cardiovascular mortality was also higher in the PCI-deferral group (adjusted HR 0.48, 95% CI 0.24-0.97, p = 0.040).

These findings suggest that deferring PCI of non-culprit lesions based on FFR > 0.80 was associated with an increased risk of combined endpoints and cardiovascular mortality compared with treating FFR-positive non-culprit lesions. The results are from an RCT substudy and should be interpreted in that context.

How this fits prior evidence

How this fits prior evidence: This finding extends the evidence regarding physiology-guided revascularization in multivessel STEMI patients, which previously showed that such guidance significantly reduces major adverse events and improves safety. This specific substudy provides a direct comparison of the risks associated with deferring treatment of non-culprit lesions based on FFR thresholds.

When someone suffers a heart attack, doctors must decide how much of the heart's plumbing to fix immediately. For patients with multiple blocked arteries, some doctors choose to only fix the artery causing the current problem. This study looked at what happens when doctors choose to fix more than one blocked artery during the initial procedure.

Researchers followed 280 patients over a period of about 10 years. They compared patients who had only one artery fixed to those who had multiple arteries treated. The results showed that patients who had multiple blockages treated had a lower risk of dying or needing urgent surgery later on. Specifically, the group where doctors treated more blockages had a lower rate of combined serious events, including death and heart attacks, compared to the group where treatment was delayed.

While the results suggest that treating more blockages is safer, it is important to remember this was a substudy of a larger trial. The findings specifically look at patients with certain types of heart disease. You should talk with your doctor to understand how these findings apply to your specific heart health and treatment plan.

What this means for you:
Treating multiple blocked heart arteries during a procedure may lower the risk of death and heart attacks.

Common questions

What did the study find about treating multiple heart blockages?

The study found that patients whose doctors treated multiple blocked arteries had a lower risk of death or heart attacks compared to those whose treatment was delayed. Specifically, the group that received treatment for more blockages had a lower rate of combined serious events, including death and the need for urgent surgery.

How long were the patients followed in this study?

The researchers followed the patients for a median of 10.5 years. This long follow-up period helped them track the long-term outcomes for patients with multiple blocked arteries after their initial heart procedure.

Who were the patients in this study?

The study included 280 patients who suffered a specific type of heart attack (STEMI) and had multivessel disease, which means they had blockages in multiple arteries supplying blood to the heart.

Study Details

Study typeRct
Sample sizen = 627
EvidenceLevel 2
PublishedNov 2026
View Original Abstract ↓
BACKGROUND: Complete revascularization is recommended in patients with ST-segment elevation myocardial infarction (STEMI) and multivessel disease. However, whether the non-culprit lesions should be evaluated using angiography or fractional flow reserve (FFR) remains uncertain. The aim of this study was to evaluate the long-term outcome of patients with STEMI and multivessel disease who had non-culprit FFR-values >0.80 and thus deferred PCI. METHODS: Of the 627 patients included in the DANAMI-3-PRIMULTI trial, 314 patients were randomized to FFR-guided complete revascularization and 280 were included in this substudy. Patients were divided into a PCI-deferral group who had no PCI of non-culprit lesions (FFR > 0.80) (n = 106) and a PCI group encompassing patients treated with PCI of at least one non-culprit lesion (FFR ≤ 0.80 or an angiographical diameter stenosis of ≥90%) (n = 174). The combined endpoint included all-cause mortality, myocardial infarction, or urgent revascularization. RESULTS: During a median follow-up of 10.5 years (IQR 9.8-11.4), the composite outcome occurred in 62 (36%) patients in the PCI group and in 50 (47%) patients in the PCI-deferral group (adjusted HR 0.64, 95% CI: 0.44-0.95, p = 0.025). PCI-deferral was associated with a significantly higher risk of cardiovascular mortality (adjusted HR 0.48, CI 95% 0.24-0.97, p = 0.040) compared to the PCI group. CONCLUSION: In patients with STEMI and multivessel disease, deferring PCI of non-culprit lesions based on FFR > 0.80 was associated with an increased risk of the combination of all-cause mortality, myocardial infarction, or urgent revascularization as well as cardiovascular mortality compared to patients treated with PCI of FFR-positive non-culprit lesions.
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