Key result
FFR-guided complete revascularization cuts MACE ~33% vs culprit-only PCI in multivessel STEMI.
Why the study?
Most studies of non-culprit lesion revascularization after primary PCI rely on visual angiographic assessment, which may misjudge functional impact and cause overtreatment.
Does FFR-guided complete revascularization reduce major adverse cardiovascular events in hemodynamically stable STEMI patients with multivessel disease compared to culprit-only primary PCI?
Meta-Analysis (n=3,054)
Does FFR-guided complete revascularization reduce major adverse cardiovascular events in hemodynamically stable STEMI patients with multivessel disease compared to culprit-only primary PCI?
Effect estimate: RR 0.67 (95% CI 0.46-0.96)
p-value: p=<0.03
FFR-guided complete revascularization reduces the risk of MACE and urgent revascularization compared to culprit-only PCI in hemodynamically stable STEMI patients with multivessel disease.
FFR-guided complete revascularization should be considered in multivessel STEMI; confirms MACE reduction versus culprit-only PCI in pooled RCTs.
Introduction Preventive stenting of non-infarct-related arteries decreased the occurrence of combined cardiovascular deaths and myocardial infarction after successful primary PCI in patients with STEMI. Most studies investigated revascularizing non-culprit lesions based on visual estimation of stenosis severity by angiography alone. However, solely relying on coronary angiographic appearance can sometimes misjudge the functional impact of a lesion, potentially causing overtreatment. Purpose To investigate the outcomes of added FFR to guide revascularization of non-infarct-related arteries in patients presenting with STEMI and multivessel disease. Methods PubMed, Cochrane, and Embase databases were systematically searched for randomized controlled trials from 2003 until 31 September 2024. The primary outcome of interest was a composite of major adverse cardiovascular events. Results The search yielded 3 randomized controlled trials. The total number of patients included was 3,054 (FFR-guided complete revascularization = 1,373; culprit-only PCI = 1,681). Our pooled estimates showed that FFR-guided CR was associated with statistically significant lower MACE (RR 0.67, 95% CI -0.46-0.96, p <0.03, I2= 84%) and urgent revascularization (RR 0.61, 95% CI 0.41-0.89, p <0.01, I2= 48%) compared with culprit-only PCI. However, there was no significant difference in terms of all-cause mortality (RR 1.08, 95% CI 0.82-1.41, p = 0.71, I2 = 0%) and MI (RR 0.95, 95% CI 0.73-1.24, p = 0.71, I2 = 0%) between the two groups. Conclusion FFR-guided complete revascularization potentially leads to better outcomes compared to culprit-only PCI in hemodynamically stable STEMI patients with multivessel disease during index hospitalization. Our analysis supports adding FFR guidance to direct revascularization decisions for non-culprit lesions in this setting.
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Isanan et al. (2025) conducted a meta-analysis in Hemodynamically stable STEMI with multivessel disease (n=3,054). FFR-guided complete revascularization vs. Culprit-only primary PCI was evaluated on Composite of major adverse cardiovascular events (RR 0.67, 95% CI 0.46-0.96, p=<0.03). FFR-guided complete revascularization reduced major adverse cardiovascular events compared to culprit-only PCI in STEMI patients with multivessel disease (RR 0.67; 95% CI 0.46-0.96; p<0.03).
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