Complete revascularization according to age in patients with ST-segment elevation myocardial infarction and multivessel disease: 10-year outcome from the DANAMI-3–PRIMULTI trial
Y Zhou, B T Oezbek, J M Marquard, U Islam, L Nepper Christensen, D E Hoefsten, A Eftekhari, C Goeransson, L Koeber, L Holmvang, H Kelbaek, N Vejlstrup, J T Loenborg, T EngstroemAbstract
Background
The benefit of complete revascularization after primary percutaneous coronary intervention (PCI) is well established in patients with ST-segment elevation myocardial infarction (STEMI) and multivessel disease, but the long-term effect in older patients remains uncertain.
Purpose
We aimed to evaluate the 10-year outcome of complete revascularization in older patients (aged ≥75 years) compared with younger patients.
Methods
Patients with STEMI and multivessel disease were randomized to either culprit-only or fractional flow reserve-guided complete revascularization in the DANAMI-3–PRIMULTI trial. This sub-study stratified the included 627 patients by ≥ 75 years (517) and < 75 years (110). The primary outcome was a composite of all-cause mortality, recurrent myocardial infarction, or any revascularization occurring during a median follow-up of 10.5 years.
Results
Of the older patients, 50 underwent complete and 60 culprit-only revascularization. Of the younger patients, 264 were completely revascularized compared to 253 who had culprit-only PCI performed. In the older group, complete revascularization showed no association with the primary outcome (adjusted hazard ratio [HR] 1.29, 95% confidence interval [CI]: 0.82-2.03, P=0.27). In contrast, complete revascularization was associated with a lower risk of the primary outcome (adjusted HR 0.68, 95% CI: 0.53-0.88, P=0.003) in younger patients, primarily driven by a reduction in any revascularization (adjusted HR 0.60, 95% CI: 0.44-0.83, P=0.002).
Conclusions
In patients aged ≥75 years, evidence of a 10-years benefit of complete revascularization was not found. Complete revascularization was associated with a 32% lower risk of adverse outcomes among younger patients, primarily driven by a reduction in repeat revascularization.Abstract illustration