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Fractional flow reserve versus angiography-guided strategy in acute myocardial infarction with multivessel disease: a randomized trial

2022; Oxford University Press; Volume: 44; Issue: 6 Linguagem: Inglês

10.1093/eurheartj/ehac763

1522-9645

Joo Myung Lee, Hyun Kuk Kim, Keun Ho Park, Eun Ho Choo, Chan Joon Kim, Seung Hun Lee, Min Chul Kim, Young Joon Hong, Sung Gyun Ahn, Joon‐Hyung Doh, Sang Yeub Lee, Sang‐Don Park, Hyun‐Jong Lee, Min Gyu Kang, Jin‐Sin Koh, Yun‐Kyeong Cho, Chang‐Wook Nam, Bon‐Kwon Koo, Bong‐Ki Lee, Kyeong Ho Yun, David Hong, Hyun Sung Joh, Ki Hong Choi, Taek Kyu Park, Jeong Hoon Yang, Young Bin Song, Seung‐Hyuk Choi, Hyeon‐Cheol Gwon, Joo‐Yong Hahn,

Cardiac Imaging and Diagnostics

Abstract Aims In patients with acute myocardial infarction (MI) and multivessel coronary artery disease, percutaneous coronary intervention (PCI) of non-infarct-related artery reduces death or MI. However, whether selective PCI guided by fractional flow reserve (FFR) is superior to routine PCI guided by angiography alone is unclear. The current trial sought to compare FFR-guided PCI with angiography-guided PCI for non-infarct-related artery lesions among patients with acute MI and multivessel disease. Methods and results Patients with acute MI and multivessel coronary artery disease who had undergone successful PCI of the infarct-related artery were randomly assigned to either FFR-guided PCI (FFR ≤0.80) or angiography-guided PCI (diameter stenosis of >50%) for non-infarct-related artery lesions. The primary end point was a composite of time to death, MI, or repeat revascularization. A total of 562 patients underwent randomization. Among them, 60.0% underwent immediate PCI for non-infarct-related artery lesions and 40.0% were treated by a staged procedure during the same hospitalization. PCI was performed for non-infarct-related artery in 64.1% in the FFR-guided PCI group and 97.1% in the angiography-guided PCI group, and resulted in significantly fewer stent used in the FFR-guided PCI group (2.2 ± 1.1 vs. 2.5 ± 0.9, P < 0.001). At a median follow-up of 3.5 years (interquartile range: 2.7–4.1 years), the primary end point occurred in 18 patients of 284 patients in the FFR-guided PCI group and in 40 of 278 patients in the angiography-guided PCI group (7.4% vs. 19.7%; hazard ratio, 0.43; 95% confidence interval, 0.25–0.75; P = 0.003). The death occurred in five patients (2.1%) in the FFR-guided PCI group and in 16 patients (8.5%) in the angiography-guided PCI group; MI in seven (2.5%) and 21 (8.9%), respectively; and unplanned revascularization in 10 (4.3%) and 16 (9.0%), respectively. Conclusion In patients with acute MI and multivessel coronary artery disease, a strategy of selective PCI using FFR-guided decision-making was superior to a strategy of routine PCI based on angiographic diameter stenosis for treatment of non-infarct-related artery lesions regarding the risk of death, MI, or repeat revascularization.