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Fractional Flow Reserve and Angiography Guided Complete Revascularization in Primary Percutaneous Coronary
Kais Hyasat1,2,3, Edmund Hasche1, Hamid Almafragy1
1Department of Cardiology, Bankstown-Lidcombe Hospital, Bankstown, NSW, Australia.
Insights
Complete revascularization in ST-elevation myocardial infarction (STEMI) reduces repeat procedures, but fractional flow reserve (FFR) guidance offers no advantage over standard angiography. Early revascularization trends favorably.
Area of Science:
- Cardiology
- Interventional Cardiology
- Clinical Trials
Background:
- ST-elevation myocardial infarction (STEMI) patients with multivessel disease often require revascularization of non-culprit lesions.
- The optimal strategy for revascularization, including the role of fractional flow reserve (FFR) guidance and timing, remains under investigation.
Purpose of the Study:
- To compare FFR-guided versus angiography-guided revascularization of non-culprit lesions in STEMI patients.
- To assess the superiority of early versus delayed complete revascularization.
- To evaluate the impact of revascularization strategies on clinical outcomes.
Main Methods:
- Network meta-analysis of 10 trials including 7981 patients.
- Comparison of complete revascularization versus culprit-only revascularization.
- Assessment of outcomes including revascularization rates, myocardial infarction, and all-cause mortality.
Main Results:
- FFR guidance did not significantly reduce all-cause death, myocardial infarction, or revascularization rates compared to angiography guidance.
- Complete revascularization significantly reduced repeat revascularization compared to culprit-only treatment, irrespective of timing.
- A trend favoring earlier revascularization was observed.
Conclusions:
- For STEMI patients with multivessel disease, complete revascularization is superior to culprit-only treatment in reducing repeat revascularization.
- FFR guidance is not superior to angiography guidance for revascularizing non-culprit lesions.
- Early complete revascularization may offer benefits, though further research is warranted.
Abstract:
Using a network meta-analysis, this study compared fractional flow reserve (FFR) guided with angiography-guided revascularization of non-culprit lesions in ST elevation myocardial infarction (STEMI). We also assessed if early complete revascularization is superior to delayed revascularization. We conducted a network meta-analysis using Net Meta XL of trials of STEMI patients with multivessel disease and compared revascularization strategies. The primary outcomes of interest were rate of revascularization, myocardial infarction, and all-cause mortality. Ten studies were included in our analysis comprising 7981 patients with 4484 patients undergoing complete revascularization and 3497 patients with culprit-only revascularization. There was no significant reduction in all-cause death, myocardial infarction, or revascularization using FFR guidance. There was significant reduction in repeat revascularization with complete revascularization irrespective of timing of percutaneous coronary intervention (PCI) compared with the culprit-only group. There was an overall trend favoring earlier revascularization. For patients with multivessel disease presenting with ST-elevation MI, complete revascularization significantly reduces repeat revascularization compared with culprit-only treatment. FFR guidance is non-superior to angiography-guided revascularization. Furthermore, there was significant reduction in repeat revascularization irrespective of timing of PCI to non-culprit vessels.
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