Non-culprit Lesion Location and FFR-guided Revascularization in Acute Myocardial Infarction With Multivessel Disease:...

Area of Science:

• Cardiology
• Interventional Cardiology
• Clinical Trials

Background:

• Prognosis of unrevascularized non-culprit lesions (NCLs) in acute myocardial infarction (AMI) with multivessel coronary disease (MVD) is debated.
• Benefits of non-culprit percutaneous coronary intervention (PCI) may depend on NCL functional significance and location.

Purpose of the Study:

• To investigate differential outcomes of FFR-guided versus angiography-guided PCI for NCLs.
• To compare outcomes based on NCL location: left anterior descending (LAD) artery vs. non-LAD arteries.

Main Methods:

• Prespecified post hoc analysis of the FRAME-AMI trial.
• Primary endpoint: composite of death, myocardial infarction, or repeat revascularization.
• Comparison of FFR-guided vs. angiography-guided PCI for NCLs, stratified by LAD and non-LAD locations.

Main Results:

• Among 562 patients, NCLs were in the LAD in 55.0% and non-LAD in 45.0%.
• FFR-guided PCI showed a lower primary outcome rate in the non-culprit LAD group (5.7% vs. 14.3%, p=0.010).
• No significant difference in outcome rates between FFR- and angiography-guided PCI in the non-culprit non-LAD group (7.4% vs. 14.5%, p=0.081).

Conclusions:

• NCL location did not significantly alter the favorable outcomes of FFR-guided PCI over angiography-guided PCI.
• FFR guidance appears beneficial for NCLs in AMI patients with MVD, particularly in the LAD territory.