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Fractional flow reserve versus angiography-guided strategy in acute myocardial infarction with multivessel disease: a
Joo Myung Lee1, Hyun Kuk Kim2, Keun Ho Park2
1Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81, Irwon-ro, Gangnam-gu, Seoul 06351, Korea.
Insights
Fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI) for non-infarct arteries in acute myocardial infarction (MI) patients with multivessel disease significantly reduced adverse events compared to angiography alone. This FFR-guided approach improved outcomes and reduced revascularization needs.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Clinical Trials
Background:
- Percutaneous coronary intervention (PCI) of non-infarct-related arteries in acute myocardial infarction (MI) patients with multivessel disease can reduce mortality and recurrent MI.
- The optimal strategy for treating these non-infarct-related lesions remains debated, specifically whether fractional flow reserve (FFR)-guided PCI offers advantages over routine angiography-guided PCI.
Purpose of the Study:
- To compare the efficacy of FFR-guided PCI versus angiography-guided PCI for non-infarct-related artery lesions in patients with acute MI and multivessel coronary artery disease.
Main Methods:
- A randomized trial involving 562 patients with acute MI and multivessel disease who had undergone successful PCI of the infarct-related artery.
- Patients were assigned to either FFR-guided PCI (FFR ≤0.80) or angiography-guided PCI (diameter stenosis >50%) for non-infarct-related lesions.
- The primary endpoint was a composite of death, MI, or repeat revascularization, assessed at a median follow-up of 3.5 years.
Main Results:
- PCI of non-infarct-related arteries was performed in 64.1% of the FFR-guided group versus 97.1% of the angiography-guided group, with fewer stents used in the FFR group (2.2 vs. 2.5).
- The primary endpoint occurred in 7.4% of the FFR-guided group versus 19.7% of the angiography-guided group (hazard ratio, 0.43; P = 0.003).
- Specific event rates showed lower death (2.1% vs. 8.5%), MI (2.5% vs. 8.9%), and unplanned revascularization (4.3% vs. 9.0%) in the FFR-guided group.
Conclusions:
- A strategy of selective PCI guided by FFR is superior to routine angiography-guided PCI for treating non-infarct-related artery lesions in patients with acute MI and multivessel disease.
- FFR-guided PCI significantly reduces the risk of death, MI, or repeat revascularization in this patient population.
Aims:
In patients with acute myocardial infarction (MI) and multivessel coronary artery disease, percutaneous coronary intervention (PCI) of non-infarct-related artery reduces death or MI. However, whether selective PCI guided by fractional flow reserve (FFR) is superior to routine PCI guided by angiography alone is unclear. The current trial sought to compare FFR-guided PCI with angiography-guided PCI for non-infarct-related artery lesions among patients with acute MI and multivessel disease.
Methods And Results:
Patients with acute MI and multivessel coronary artery disease who had undergone successful PCI of the infarct-related artery were randomly assigned to either FFR-guided PCI (FFR ≤0.80) or angiography-guided PCI (diameter stenosis of >50%) for non-infarct-related artery lesions. The primary end point was a composite of time to death, MI, or repeat revascularization. A total of 562 patients underwent randomization. Among them, 60.0% underwent immediate PCI for non-infarct-related artery lesions and 40.0% were treated by a staged procedure during the same hospitalization. PCI was performed for non-infarct-related artery in 64.1% in the FFR-guided PCI group and 97.1% in the angiography-guided PCI group, and resulted in significantly fewer stent used in the FFR-guided PCI group (2.2 ± 1.1 vs. 2.5 ± 0.9, P < 0.001). At a median follow-up of 3.5 years (interquartile range: 2.7-4.1 years), the primary end point occurred in 18 patients of 284 patients in the FFR-guided PCI group and in 40 of 278 patients in the angiography-guided PCI group (7.4% vs. 19.7%; hazard ratio, 0.43; 95% confidence interval, 0.25-0.75; P = 0.003). The death occurred in five patients (2.1%) in the FFR-guided PCI group and in 16 patients (8.5%) in the angiography-guided PCI group; MI in seven (2.5%) and 21 (8.9%), respectively; and unplanned revascularization in 10 (4.3%) and 16 (9.0%), respectively.
Conclusion:
In patients with acute MI and multivessel coronary artery disease, a strategy of selective PCI using FFR-guided decision-making was superior to a strategy of routine PCI based on angiographic diameter stenosis for treatment of non-infarct-related artery lesions regarding the risk of death, MI, or repeat revascularization.
