Comparing FFR-Guided Complete Revascularization and Conservative Management for Non-Culprit Lesions in STEMI Patients...

Area of Science:

• Cardiovascular Medicine
• Interventional Cardiology
• Clinical Trials

Background:

• Management of non-culprit lesions in ST-elevation myocardial infarction (STEMI) with multivessel coronary artery disease remains debated.
• Physiology-guided assessment, using techniques like fractional flow reserve (FFR), is increasingly employed to determine the need for stenting non-culprit lesions.

Purpose of the Study:

• To compare the efficacy and safety of FFR-guided management versus conservative management for non-culprit lesions in STEMI patients with multivessel disease.

Main Methods:

• A systematic literature search was conducted up to May 25, 2024.
• A random-effects meta-analysis of five randomized controlled trials (RCTs) involving 3759 patients was performed.

Main Results:

• FFR-guided management significantly reduced major adverse cardiovascular events (MACE), repeat revascularization, and hospitalizations compared to conservative care.
• While FFR-guided PCI lowered MACE and revascularization rates, it was associated with a higher incidence of definite stent thrombosis.
• No significant differences were found in mortality, heart failure hospitalizations, myocardial infarction, bleeding, cerebrovascular accidents, or contrast-induced nephropathy.

Conclusions:

• FFR-guided percutaneous coronary intervention (PCI) for non-culprit lesions in STEMI patients with multivessel disease appears safe and improves clinical outcomes.
• Reduced revascularization and hospitalization rates are key benefits, though the increased risk of stent thrombosis necessitates careful consideration of procedural complexity and patient factors.