Joshi, Francis R.;
Lønborg, Jacob;
Sadjadieh, Golnaz;
Helqvist, Steffen;
Holmvang, Lene;
Sørensen, Rikke;
Jørgensen, Erik;
Pedersen, Frants;
Tilsted, Hans Henrik;
Høfsten, Dan;
Køber, Lars;
Kelbæk, Henning;
Engstrøm, Thomas
The benefit of complete revascularization after primary PCI for STEMI is attenuated by increasing age: Results from the DANAMI‐3‐PRIMULTI randomized study
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Media type:
E-Article
Title:
The benefit of complete revascularization after primary PCI for STEMI is attenuated by increasing age: Results from the DANAMI‐3‐PRIMULTI randomized study
Contributor:
Joshi, Francis R.;
Lønborg, Jacob;
Sadjadieh, Golnaz;
Helqvist, Steffen;
Holmvang, Lene;
Sørensen, Rikke;
Jørgensen, Erik;
Pedersen, Frants;
Tilsted, Hans Henrik;
Høfsten, Dan;
Køber, Lars;
Kelbæk, Henning;
Engstrøm, Thomas
Published:
Wiley, 2021
Published in:
Catheterization and Cardiovascular Interventions, 97 (2021) 4
Description:
<jats:title>Abstract</jats:title><jats:sec><jats:title>Objectives</jats:title><jats:p>To ascertain the effect of age on outcomes after culprit‐only and complete revascularization after Primary PCI (PPCI) for ST‐elevation myocardial infarction (STEMI).</jats:p></jats:sec><jats:sec><jats:title>Background</jats:title><jats:p>The numbers of older patients being treated with PPCI are increasing. The optimal management of nonculprit stenoses in such patients is unclear.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>We conducted an analysis of patients aged ≥75 years randomized in the DANAMI‐3‐PRIMULTI study to either culprit‐only or complete FFR‐guided revascularization. The primary endpoint was a composite of all‐cause mortality, nonfatal reinfarction, and ischaemia‐driven revascularization of lesions in noninfarct‐related arteries after a median of 27 months of follow‐up.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>One hundred and ten of six hundred and twenty seven patients in the DANAMI‐3‐PRIMULTI trial were aged ≥75 years. These patients were more likely female (<jats:italic>p</jats:italic> < .001), hypertensive (<jats:italic>p</jats:italic> < .001), had lower hemoglobin levels (<jats:italic>p</jats:italic> < .001), and higher serum creatinine levels (<jats:italic>p</jats:italic> < .001) than the younger patients in the trial. Other than less use of drug‐eluting stents (96.6 versus 88.0%: <jats:italic>p</jats:italic> = .02), there were no significant differences in procedural technique and success between patients aged <75 years and those ≥75 years of age. There was no significant difference in the incidence of the primary endpoint in patients ≥75 years randomized to culprit‐only or FFR‐guided complete revascularization (HR 1.49 [95% CI 0.57–4.65]; log‐rank <jats:italic>p</jats:italic> = .19; <jats:italic>p</jats:italic> for interaction versus patients <75 years <.001). There was a significant interaction between age as a continuous variable, treatment assignment, and the primary outcome (<jats:italic>p</jats:italic> < .001); beyond the age of about 75 years, there may be no prognostic advantage to complete revascularization.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>In patients ≥75 years, after treatment of the culprit lesion in STEMI, there is no significant prognostic benefit to prophylactic complete revascularization of nonculprit stenoses. Pending further study, data would support a symptom‐guided approach to further invasive treatment.</jats:p></jats:sec>