Key result
Incomplete caFFR-based revascularization linked to ~90% higher MACE risk versus complete revascularization in STEMI.
Why the study?
Nearly half of STEMI patients present with significant multivessel CAD and remain at high risk for adverse events, but whether caFFR-guided complete revascularization reduces this risk is not fully investigated.
Does functional complete revascularization based on caFFR improve long-term MACE compared to incomplete revascularization in STEMI patients undergoing primary PCI?
Cohort (n=367)
No
Does functional complete revascularization based on caFFR improve long-term MACE compared to incomplete revascularization in STEMI patients undergoing primary PCI?
In STEMI patients undergoing primary PCI, incomplete revascularization defined by post-PCI caFFR ≤ 0.8 is associated with a nearly two-fold higher risk of long-term MACE compared to functional complete revascularization.
caFFR-defined incomplete revascularization associated with higher MACE post-STEMI PCI; leaves open whether targeting functional completeness improves outcomes.
BACKGROUND: Nearly half of ST-segment elevation myocardial infarction (STEMI) patients present with significant multivessel coronary artery disease, they are at high risk of subsequent adverse events. Whether complete revascularization guided by coronary angiography-derived fractional flow reserve (caFFR) further reduces such events risk is not fully investigated. METHODS: In this study, 367 consecutive STEMI patients who underwent successful primary percutaneous coronary intervention (PCI) were enrolled. caFFR of all three coronary vessels were measured, including 367 culprit vessels and 703 non-culprit vessels. Complete revascularization was defined as post-PCI caFFR > 0.8 of all three coronary vessels. The primary endpoint was major adverse cardiovascular events (MACE, a composite of cardiovascular death, non-fatal recurrent myocardial infarction, ischemia-driven revascularization and non-fatal stroke/transient ischemic attacks) during follow-up. RESULTS: At a median follow-up of 3.8 years, MACE had occurred in 39 patients of the 220 (17.7%) in the complete revascularization group as compared with 49 patients of the 131 (37.4%) in the incomplete revascularization group (hazard ratio [HR] 1.9; 95% confidence interval [CI] 1.2-3.0; p = 0.005). The incomplete revascularization in culprit vessels evaluated by caFFR showed the highest risk for MACE occurrence. CONCLUSIONS: In STEMI patients with multivessel coronary artery disease, incomplete revascularization based on caFFR might contribute to identifying patients at high-risk.
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Liu et al. (2023) conducted a cohort in ST-segment elevation myocardial infarction (STEMI) (n=367). Functional complete revascularization (post-PCI caFFR > 0.8) vs. Incomplete revascularization (any coronary vessel post-PCI caFFR ≤ 0.8) was evaluated on Major adverse cardiovascular events (MACE) (HR 1.9, 95% CI 1.2-3.0, p=0.005). Incomplete revascularization based on caFFR significantly increased the risk of major adverse cardiovascular events (HR 1.9) compared to complete revascularization in STEMI patients.
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