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Revascularization Strategies in Patients With ST-Segment Elevation Myocardial Infarction and Multivessel Disease: Is

Doosup Shin1, Tae-Min Rhee2, Seung Hun Lee3

  • 1Division of Cardiovascular Medicine, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA.

Korean Circulation Journal
|April 7, 2022
PubMed

Insights

Complete revascularization (CR) using angiography or fractional flow reserve (FFR) guidance is superior to culprit-only percutaneous coronary intervention (PCI) for ST-segment elevated myocardial infarction (STEMI) patients with multivessel disease (MVD). Angiography and FFR-guided CR show similar safety and efficacy.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Clinical Trials

Background:

  • Complete revascularization (CR) benefits ST-segment elevated myocardial infarction (STEMI) patients with multivessel disease (MVD) over culprit-only percutaneous coronary intervention (PCI).
  • Optimal strategies for non-culprit PCI target selection in STEMI with MVD remain unclear.

Purpose of the Study:

  • To compare the safety and efficacy of different CR strategies in STEMI patients with MVD.
  • To evaluate angiography-guided versus fractional flow reserve (FFR)-guided CR using Bayesian network meta-analysis.

Main Methods:

  • Bayesian network meta-analysis of 13 randomized controlled trials (RCTs).
  • Comparison of culprit-only PCI, angiography-guided CR, and FFR-guided CR.
  • Assessment of major adverse cardiac events (MACE) and its components.

Main Results:

  • Culprit-only PCI showed a higher risk of MACE compared to both angiography-guided and FFR-guided CR.
  • No significant difference in MACE or its components between angiography-guided and FFR-guided CR.
  • FFR-guided CR may use fewer stents than angiography-guided CR for intermediate lesions.

Conclusions:

  • Both angiography-guided and FFR-guided CR are reasonable options for STEMI patients with MVD.
  • FFR-guided CR is a reliable tool for intermediate or unclear lesions, potentially reducing stent usage.
  • Further RCTs, like the FRAME-AMI trial, are needed for direct comparison.

Keywords:
Acute myocardial infarctionFractional flow reserveMeta-analysisPercutaneous coronary interventionST-segment elevation myocardial infarction

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