Non-culprit Lesion Location and FFR-guided Revascularization in Acute Myocardial Infarction With Multivessel Disease:
Ho Sung Jeon1, Jung-Hee Lee1, Jun-Won Lee1
1Division of Cardiology, Department of Internal Medicine, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea.
Insights
Fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI) offers favorable outcomes for non-culprit lesions (NCLs) in acute myocardial infarction (AMI) patients with multivessel coronary disease (MVD), regardless of lesion location. This approach proved beneficial in the left anterior descending artery (LAD) and showed a trend in non-LAD arteries.
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.
Background And Objectives:
The prognosis of unrevascularized non-culprit lesions (NCLs) and the benefits of non-culprit percutaneous coronary intervention (PCI) may depend on their functional significance and location in patients with acute myocardial infarction (AMI) and multivessel coronary disease (MVD). We investigated the differential outcomes of fractional flow reserve (FFR) versus angiography-guided PCI for NCL between the left anterior descending artery (LAD) and non-LAD arteries.
Methods:
This was a prespecified post hoc analysis of the FRAME-AMI trial. The primary endpoint, a composite of time to death, myocardial infarction, or repeat revascularization, was matched between the two strategies according to the NCL location.
Results:
Among 562 patients, the proportions of NCL in the LAD and non-LAD groups were 55.0% and 45.0%, respectively. PCI rates (82.2% vs. 78.3%; p=0.242) and the primary outcome (9.4% vs. 11.5%; p=0.421) were comparable between the two groups. In the non-culprit LAD group, FFR-guided PCI was associated with a lower rate of the primary outcome compared to angiography-guided PCI (5.7% vs. 14.3%, p=0.010). In the non-culprit non-LAD group, the outcome rate did not significantly differ between FFR- and angiography-guided PCI (7.4% vs. 14.5%, p=0.081). Nevertheless, the interaction between the non-culprit location and FFR- or angiography-guided PCI did not affect the primary outcome (p=0.667).
Conclusions:
The NCL location did not affect the favorable outcomes of FFR-guided PCI over angiography-guided PCI in patients with AMI and MVD.
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