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FFR- Versus Angiography-Guided Revascularization for Nonculprit Stenosis in STEMI and Multivessel Disease: A Network

Ayman Elbadawi1, Alexander T Dang2, Mohamed Hamed3

  • 1Division of Cardiology, Baylor College of Medicine, Houston, Texas, USA.

JACC. Cardiovascular Interventions
|March 25, 2022
PubMed

Insights

Complete revascularization (CR) guided by either angiography or fractional flow reserve (FFR) reduces adverse events in ST-segment elevation myocardial infarction (STEMI) patients with multivessel disease. FFR-guided CR offers no significant advantage over angiography-guided CR.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Clinical Trials

Background:

  • The optimal strategy for revascularizing nonculprit lesions in patients with ST-segment elevation myocardial infarction (STEMI) and multivessel disease is not well-established.
  • Current approaches include culprit-only revascularization, angiography-guided complete revascularization (CR), and fractional flow reserve (FFR)-guided CR.

Purpose of the Study:

  • To compare the efficacy and safety of FFR-guided versus angiography-guided CR for nonculprit stenosis in STEMI patients with multivessel disease.
  • To evaluate the impact of different revascularization strategies on major adverse cardiac events (MACE).

Main Methods:

  • A systematic search of electronic databases identified randomized trials comparing culprit-only revascularization, angiography-guided CR, and FFR-guided CR.
  • Pairwise and network meta-analyses were performed to compare outcomes, with MACE as the primary endpoint.

Main Results:

  • Complete revascularization (angiography- or FFR-guided) significantly reduced MACE, cardiovascular mortality, recurrent myocardial infarction, and repeat ischemia-driven revascularization compared to culprit-only revascularization.
  • Both angiography-guided CR and FFR-guided CR showed lower MACE rates than culprit-only revascularization.
  • No significant difference in MACE was observed between angiography-guided CR and FFR-guided CR.

Conclusions:

  • Complete revascularization, whether guided by angiography or FFR, is associated with improved outcomes in STEMI patients with multivessel disease compared to culprit-only revascularization.
  • FFR-guided CR is not superior to angiography-guided CR in reducing adverse events.
  • Further research is needed to identify optimal tools for risk-stratifying nonculprit stenoses.
Abstract

Keywords:
FFRSTEMIangiographycomplete revascularizationmultivessel disease

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