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Fractional flow reserve-guided PCI in patients with and without left ventricular hypertrophy: a DANAMI-3-PRIMULTI

Muhammad Sabbah1, Lars Nepper-Christensen, Jacob Lønborg

  • 1Department of Cardiology, Rigshospitalet - Copenhagen University Hospital, Copenhagen, Denmark.

Eurointervention : Journal of Europcr in Collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology
|November 21, 2019
PubMed

Insights

Left ventricular hypertrophy (LVH) does not affect the relationship between fractional flow reserve (FFR) and diameter stenosis in STEMI patients. Complete revascularization guided by FFR improves outcomes regardless of LVH presence.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Cardiac Imaging

Background:

  • Left ventricular hypertrophy (LVH) is common in ST-elevation myocardial infarction (STEMI) patients.
  • The correlation between fractional flow reserve (FFR) and diameter stenosis, and its clinical implications, may be affected by LVH.
  • Optimal revascularization strategies in STEMI patients with LVH require further investigation.

Purpose of the Study:

  • To investigate the correlation between FFR and diameter stenosis in STEMI patients with and without LVH.
  • To assess the influence of LVH on the clinical outcomes of complete FFR-guided revascularization versus culprit-lesion-only revascularization.

Main Methods:

  • Substudy of the DANAMI-3-PRIMULTI trial involving 279 STEMI patients.
  • Cardiac magnetic resonance (CMR) imaging for LVH assessment.
  • FFR evaluation and quantitative coronary analysis of non-culprit lesions in 96 patients.

Main Results:

  • A significant correlation between diameter stenosis and FFR was observed in both groups (with and without LVH), with no significant difference between groups (p=0.38 for stenosis, p=0.34 for FFR).
  • FFR-guided complete revascularization reduced the risk of death, myocardial infarction, or ischemia-driven revascularization in both STEMI patients without LVH (HR 0.42) and with LVH (HR 0.50).
  • No interaction was found between LVH and the benefit of complete revascularization (p=0.82).

Conclusions:

  • LVH does not alter the correlation between diameter stenosis and FFR in STEMI patients.
  • Complete FFR-guided revascularization improves clinical outcomes in STEMI patients, irrespective of LVH status.
  • FFR remains a valuable tool for guiding revascularization decisions in STEMI patients with or without LVH.
Abstract

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