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Published on: June 28, 2019
Complete revascularization based on angiography derived fractional flow reserve versus incomplete revascularization
Jiahui Liu1,2, Kaiping Zhang3, Xingang Wang1
1Department of Cardiology, Peking University First Hospital, Beijing, China.
Insights
Complete revascularization guided by coronary angiography-derived fractional flow reserve (caFFR) significantly reduces major adverse cardiovascular events (MACE) in ST-segment elevation myocardial infarction (STEMI) patients with multivessel coronary artery disease. Incomplete revascularization identified high-risk patients.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Medicine
Background:
- ST-segment elevation myocardial infarction (STEMI) patients often have multivessel coronary artery disease, increasing their risk of adverse events.
- The benefit of complete revascularization guided by coronary angiography-derived fractional flow reserve (caFFR) in these high-risk patients remains under investigation.
Purpose of the Study:
- To investigate whether complete revascularization, assessed by caFFR, reduces major adverse cardiovascular events (MACE) in STEMI patients with multivessel coronary artery disease.
Main Methods:
- 367 STEMI patients with successful primary percutaneous coronary intervention (PCI) were enrolled.
- Coronary angiography-derived fractional flow reserve (caFFR) was measured for all coronary vessels.
- Complete revascularization was defined as post-PCI caFFR > 0.8 in all three coronary vessels. The primary endpoint was MACE.
Main Results:
- At a median follow-up of 3.8 years, MACE occurred in 17.7% of patients with complete revascularization versus 37.4% with incomplete revascularization (HR 1.9; p=0.005).
- Incomplete revascularization of culprit vessels, evaluated by caFFR, was associated with the highest risk of MACE.
Conclusions:
- In STEMI patients with multivessel coronary artery disease, incomplete revascularization identified by caFFR is linked to higher MACE risk.
- caFFR-guided revascularization strategies may help identify high-risk STEMI patients needing further intervention.
Background:
Nearly half of ST-segment elevation myocardial infarction (STEMI) patients present with significant multivessel coronary artery disease, they are at high risk of subsequent adverse events. Whether complete revascularization guided by coronary angiography-derived fractional flow reserve (caFFR) further reduces such events risk is not fully investigated.
Methods:
In this study, 367 consecutive STEMI patients who underwent successful primary percutaneous coronary intervention (PCI) were enrolled. caFFR of all three coronary vessels were measured, including 367 culprit vessels and 703 non-culprit vessels. Complete revascularization was defined as post-PCI caFFR > 0.8 of all three coronary vessels. The primary endpoint was major adverse cardiovascular events (MACE, a composite of cardiovascular death, non-fatal recurrent myocardial infarction, ischemia-driven revascularization and non-fatal stroke/transient ischemic attacks) during follow-up.
Results:
At a median follow-up of 3.8 years, MACE had occurred in 39 patients of the 220 (17.7%) in the complete revascularization group as compared with 49 patients of the 131 (37.4%) in the incomplete revascularization group (hazard ratio [HR] 1.9; 95% confidence interval [CI] 1.2-3.0; p = 0.005). The incomplete revascularization in culprit vessels evaluated by caFFR showed the highest risk for MACE occurrence.
Conclusions:
In STEMI patients with multivessel coronary artery disease, incomplete revascularization based on caFFR might contribute to identifying patients at high-risk.
