Multivessel PCI guided by FFR not superior to angiography for STEMI patients: Study
Delhi: A fractional flow reserve (FFR) guided strategy is of no significant benefit over an angiography-guided strategy for STEMI patients undergoing complete revascularization, the researchers state in a recent study in the New England Journal of Medicine. The benefit was measured with respect to the risk of myocardial infarction, death, or urgent revascularization at 1 year.
The findings, however, do not allow for a conclusive interpretation given the wide confidence intervals for the estimate of effect, note the authors.
In ST-elevation myocardial infarction (STEMI) patients having multivessel disease, percutaneous coronary intervention (PCI) for nonculprit lesions (complete revascularization) is superior to the treatment of culprit lesion alone. However, it is not known if complete revascularization guiidded by FFR is superior to an angiography-guided procedure.
To determine the same, Etienne Puymirat and colleagues conducted FLOWER-MI- a multicenter trial consisting of patients with STEMI and multivessel disease who had undergone successful PCI of the infarct-related artery. They were randomized to receive complete revascularization guided by either FFR or angiography.
The primary outcome was a composite of death from any cause, nonfatal myocardial infarction, or unplanned hospitalization leading to urgent revascularization at 1 year.
Key findings of the study include:
- The mean number of stents that were placed per patient for nonculprit lesions was 1.01 in the FFR-guided group and 1.50 in the angiography-guided group.
- During follow-up, a primary outcome event occurred in 5.5% patients in the FFR-guided group and in 4.2% in the angiography-guided group (hazard ratio, 1.32).
- Death occurred in 1.5% in the FFR-guided group and in 10 1.7% in the angiography-guided group; nonfatal myocardial infarction in 3.1% and 10 1.7%, respectively; and unplanned hospitalization leading to urgent revascularization in 2.6% and 1.9%, respectively.
"Our findings showed that in patients with STEMI undergoing complete revascularization, an FFR-guided strategy did not have a significant benefit over an angiography-guided strategy with respect to the risk of death, myocardial infarction, or urgent revascularization at 1 year," concluded the authors.
Reference:
The study titled, "Multivessel PCI Guided by FFR or Angiography for Myocardial Infarction," is published in the New England Journal of Medicine.
DOI: https://www.nejm.org/doi/full/10.1056/NEJMoa2104650
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