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When Results Also Allow the Opposite Conclusion…

Published:October 07, 2015DOI:https://doi.org/10.1016/j.amjcard.2015.10.002
      The straight forward DANAMI-3–PRIMULTI trial
      • Engstrøm T.
      • Kelbæk H.
      • Helqvist S.
      • Høfsten D.E.
      • Kløvgaard L.
      • Holmvang L.
      • Jørgensen E.
      • Pedersen F.
      • Saunamäki K.
      • Clemmensen P.
      • De Backer O.
      • Ravkilde J.
      • Tilsted H.H.
      • Villadsen A.B.
      • Aarøe J.
      • Jensen S.E.
      • Raungaard B.
      • Køber L.
      for the DANAMI-3—PRIMULTI Investigators
      Complete revascularization versus treatment of the culprit lesion only in patients with ST-segment elevation myocardial infarction and multivessel disease (DANAMI-3—PRIMULTI): an open-label, randomised controlled trial.
      showed that patients with ST-elevation myocardial infarction and multivessel disease, who had timely primary percutaneous coronary intervention, benefitted from fractional flow reserve–guided revascularizations of lesions in non–infarct-related arteries during the index admission. The investigators reported “a significant reduction in the combination of all-cause mortality, nonfatal reinfarction, and ischemia-driven revascularization of coronary artery lesions located remotely from the culprit artery.” These impressive sounding results lose some of their glamour when the reader realizes that, because all-cause mortality and nonfatal reinfarction did not differ between groups, the effect was driven solely by fewer repeat revascularizations.
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      References

        • Engstrøm T.
        • Kelbæk H.
        • Helqvist S.
        • Høfsten D.E.
        • Kløvgaard L.
        • Holmvang L.
        • Jørgensen E.
        • Pedersen F.
        • Saunamäki K.
        • Clemmensen P.
        • De Backer O.
        • Ravkilde J.
        • Tilsted H.H.
        • Villadsen A.B.
        • Aarøe J.
        • Jensen S.E.
        • Raungaard B.
        • Køber L.
        • for the DANAMI-3—PRIMULTI Investigators
        Complete revascularization versus treatment of the culprit lesion only in patients with ST-segment elevation myocardial infarction and multivessel disease (DANAMI-3—PRIMULTI): an open-label, randomised controlled trial.
        Lancet. 2015; 386: 665-671
        • Bangalore S.
        • Toklu B.
        • Watershed J.
        Complete versus culprit-only revascularization for ST-segment-elevation myocardial infarction and multivessel disease: a meta-analysis and trial sequential analysis of randomized trials.
        Circ Cardiovasc Interv. 2015; 8: e002142