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Published on: March 12, 2018
Multivessel PCI Guided by FFR or Angiography for Myocardial Infarction
Etienne Puymirat1, Guillaume Cayla1, Tabassome Simon1
1From Assistance Publique-Hôpitaux de Paris (AP-HP), Department of Cardiology, Hôpital Européen Georges Pompidou, Université de Paris, INSERM, Paris Centre de Recherche Cardiovasculaire (E.P., D.B., N.D.), AP-HP, Hôpital Saint Antoine, Department of Clinical Pharmacology and Unité de Recherche Clinique, Sorbonne Université, INSERM Unité 698 (T.S.), Université de Paris, INSERM Unité 1148, and Hôpital Bichat, AP-HP (P.G.S.), Sorbonne Université, ACTION Study Group, Institut de Cardiologie (AP-HP), INSERM UMRS 1166, Hôpital Pitié-Salpêtrière (G.M., J.S.), Clinical Research Unit Eco Ile de France, Hôpital Hôtel Dieu, AP-HP (I.D.-Z., A.B.), the Department of Cardiology, Hôpital Lariboisière, AP-HP, INSERM Unité 942, Université de Paris (J.-G.D.), the Department of Cardiology, Hôpital Bichat, AP-HP, French Alliance for Cardiovascular Trials, INSERM Unité 1148, Laboratory for Vascular Translational Science, Université de Paris (G.D.), the Clinical Research Unit and Centre d'Investigation Clinique 1418 INSERM, George Pompidou European Hospital, AP-HP (A.C.N., G. Chatellier), and the French Alliance for Cardiovascular Trials (E.P., T.S., P.G.S., G.L., D.B., G.D., N.D.), Paris, Centre Hospitalier Universitaire (CHU) de Nîmes, Nîmes (G. Cayla), Service de Cardiologie, AP-HP, Université de Paris Est Créteil, Hôpitaux Universitaires Henri Mondor, Créteil, and Unité 955-Mondor Institute for Biomedical Research, Equipe 03, INSERM, Ecole Nationale Vétérinaire d'Alfort, Maisons-Alfort (R.G.), Hôpital du Bon Secours, Metz (K.K.), Clinique St. Martin (J.-F.M.) and the Cardiology Department, Caen University Hospital (V.R.), Caen, the Department of Cardiology, CHU Clermont-Ferrand, CNRS UMR 6602, Université Clermont Auvergne, Clermont-Ferrand, the Cardiac Intensive Care Unit, Heart and Lung Institute, CHU Lille (P.M.), and the Heart and Lung Institute, University Hospital of Lille, Institut Pasteur of Lille, INSERM Unité 1011 (G.L.), Lille, and the Intensive Cardiac Care Unit, Department of Cardiology, Rangueil University Hospital, and the Medical School, Toulouse III Paul Sabatier University, Toulouse (T.L.), Groupement de Coopération Saintaire de Cardiologie de la Côte Basque, Centre Hospitalier de la Côte Basque, Bayonne (J.-N.L.), the Cardiology Department, Hôpitaux de Chartres, Chartres (G.R.), and Physiopathologie et Epidémiologie Cérébro-Cardiovasculaires, Equipe d'Accueil (EA 7460), University of Bourgogne Franche-Comté, and the Cardiology Department, University Hospital Center of Dijon Bourgogne, Dijon (Y.C.) - all in France; Cardiovascular Center Aalst, Aalst, Belgium (B.D.B.); and the Department of Cardiology, Lausanne University Center Hospital, Lausanne, Switzerland (B.D.B.).
Fractional flow reserve (FFR) guided complete revascularization in ST-elevation myocardial infarction (STEMI) patients did not significantly improve outcomes compared to angiography guidance. Further research is needed for conclusive interpretation due to wide confidence intervals.
Area of Science:
- Cardiology
- Interventional Cardiology
- Clinical Trials
Background:
- Complete revascularization in STEMI patients with multivessel disease is superior to culprit-lesion-only PCI.
- The benefit of FFR-guided complete revascularization over angiography-guided procedures remains unclear.
Purpose of the Study:
- To compare the efficacy of FFR-guided versus angiography-guided complete revascularization in STEMI patients with multivessel disease.
Main Methods:
- A multicenter trial randomly assigned STEMI patients with multivessel disease to FFR-guided or angiography-guided complete revascularization.
- The primary outcome was a composite of death, nonfatal myocardial infarction, or urgent revascularization at 1 year.
Main Results:
- The FFR-guided group had 5.5% primary outcome events versus 4.2% in the angiography-guided group (HR, 1.32; 95% CI, 0.78-2.23).
- No significant difference was observed in death, myocardial infarction, or urgent revascularization rates between the groups.
Conclusions:
- FFR-guided complete revascularization did not offer significant advantages over angiography-guided strategy in STEMI patients at 1 year.
- Wide confidence intervals preclude a definitive conclusion, necessitating further investigation.
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