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Evaluation of Coronary Flow Reserve After Myocardial Ischemia Reperfusion in Rats
06:32

Evaluation of Coronary Flow Reserve After Myocardial Ischemia Reperfusion in Rats

Published on: June 28, 2019

Fractional flow reserve-guided complete vs. culprit-only revascularization in ST-elevation myocardial infarction

Jingxian Yang1,2, Peng Wang2, Jun Wan1

  • 1Center for Evidence-based Medicine, Affiliated Hospital of Chengdu University, Chengdu, Sichuan, China.

Frontiers in Cardiovascular Medicine
|March 26, 2025
PubMed

Insights

Fractional flow reserve (FFR)-guided complete revascularization (CR) in ST-elevation myocardial infarction (STEMI) patients with multivessel disease reduces major adverse cardiac events and repeat interventions compared to culprit-only revascularization (COR). Benefits may vary, with no impact on all-cause mortality.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Clinical Trials

Background:

  • ST-elevation myocardial infarction (STEMI) with multivessel disease presents treatment challenges.
  • The optimal revascularization strategy remains debated: complete revascularization (CR) versus culprit-only revascularization (COR).
  • Fractional flow reserve (FFR) guidance for CR is a potential advancement.

Purpose of the Study:

  • To compare the efficacy and safety of FFR-guided CR versus COR in STEMI patients with multivessel disease.
  • To evaluate the impact on major adverse cardiac events (MACE) and need for revascularization.

Main Methods:

  • A systematic meta-analysis of randomized controlled trials (RCTs) was performed.
  • Searches included PubMed, Embase, Cochrane Library, and CNKI.
  • Data extraction and analysis followed Cochrane guidelines, focusing on MACE as the primary outcome.

Main Results:

  • Six RCTs involving 3,482 patients were analyzed.
  • FFR-guided CR significantly reduced MACE (RR: 0.66) and ischemia-driven revascularization (RR: 0.27) compared to COR.
  • Repeat percutaneous coronary interventions were also lower with FFR-guided CR (RR: 0.35), with no significant difference in all-cause mortality.

Conclusions:

  • FFR-guided CR is superior to COR in reducing MACE and repeat interventions in STEMI patients with multivessel disease.
  • While FFR-guided CR demonstrates significant benefits, the clinical impact may vary.
  • No significant difference in all-cause mortality or safety outcomes was observed between the two strategies.
Abstract

Keywords:
ST-elevation myocardial infarctionfractional flow reservemultivesselmyocardial infarctionrevascularization

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