Fractional Flow Reserve-Guided Complete vs Culprit-Only Revascularization in Non-ST-Elevation Myocardial Infarction...

Area of Science:

• Cardiology
• Interventional Cardiology
• Clinical Trials

Background:

• The optimal revascularization strategy for patients with non-ST-segment elevation myocardial infarction (NSTEMI) and multivessel disease is not fully established.
• Fractional flow reserve (FFR) is a key modality for assessing the functional significance of coronary stenoses.

Purpose of the Study:

• To compare the efficacy of FFR-guided complete coronary revascularization versus culprit-lesion-only revascularization in patients with NSTEMI and multivessel disease.

Main Methods:

• A prospective, international, multicenter randomized clinical trial involving 478 patients with NSTEMI and multivessel disease.
• Patients were randomized to either FFR-guided complete revascularization or culprit-only revascularization during the index procedure.

Main Results:

• FFR-guided complete revascularization significantly reduced the composite primary outcome (all-cause death, nonfatal myocardial infarction, any revascularization, stroke) at 1 year (5.5% vs 13.6%, P=.003).
• Rates of repeat revascularization and net adverse clinical events were also significantly lower in the complete revascularization group.
• No significant differences were observed in other secondary outcomes between the groups.

Conclusions:

• FFR-guided complete revascularization is associated with improved clinical outcomes in patients with NSTEMI and multivessel disease.
• This strategy is particularly effective in reducing the need for subsequent revascularization procedures.