The straight forward DANAMI-3–PRIMULTI 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.

In other words, what the investigators are showing is that a fractional flow reserve of 0.80 or less identifies coronary lesions in need of ischemia-driven revascularization within 3 years. Whether such revascularization was done during index admission or subsequently had no bearing on outcome, that is, all-cause mortality or nonfatal myocardial infarction. The take home message of the study is that after primary percutaneous coronary intervention, a wait and see approach is equally justified as aggressive multivessel revascularization, which prolongs the procedure time and exposes patients to more contrast volume.

We want to make it clear that as clinicians, we basically agree with the dictum of the investigators as do most of the reports. However, instead of stating “to avoid repeat revascularization, patients can safely have all their lesions treated during the index admission,” the results of the study equally allow to state the opposite, namely, “to avoid a second intervention with aggressive multivessel revascularization during the index admission, patients can safely wait and see whether revascularization will be needed at all.”