Fractional Flow Reserve and Angiography Guided Complete Revascularization in Primary Percutaneous Coronary...

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.