Key result
Discordance between vFFR and treatment strategy occurred in 21.1% of non-culprit vessels and was associated with lower 2-year freedom from VOCE compared to concordance (90.6% vs 97.5%, p=0.003).
Why the study?
Complete revascularization improves outcomes in STEMI, but the extent of discordance between vessel fractional flow reserve (vFFR) reclassification and actual treatment in intermediate non-culprit lesions, and its clinical impact, remained unknown.
Does discordance between vFFR reclassification and actual treatment strategy impact clinical outcomes in STEMI patients with intermediate non-culprit lesions?
Cohort (n=441)
No
Does discordance between vFFR reclassification and actual treatment strategy impact clinical outcomes in STEMI patients with intermediate non-culprit lesions?
In STEMI patients with multivessel disease, discordance between offline vFFR and actual treatment of intermediate non-culprit lesions is common and associated with worse clinical outcomes, particularly when revascularization is deferred in physiologically significant lesions.
Discordance in vFFR reclassification of STEMI non-culprit lesions warrants caution in treatment decisions; leaves open its clinical utility pending prospective validation.
BACKGROUND: Complete revascularization in patients with ST-segment elevation myocardial (STEMI) improves clinical outcome. Vessel fractional flow reserve (vFFR) has been validated as a non-invasive physiological technology to evaluate hemodynamic lesion significance without need for a dedicated pressure wire or hyperemic agent. This study aimed to assess discordance between vFFR reclassification and treatment strategy in intermediate non-culprit lesions of STEMI patients and to assess the clinical impact of this discordance. METHODS: This was a single-center, retrospective cohort study. From January 2018 to December 2019, consecutive eligible STEMI patients were screened based on the presence of a non-culprit vessel with an intermediate lesion (30-80% angiographic stenosis) feasible for offline vFFR analysis. The primary outcome was the percentage of non-culprit vessels with discordance between vFFR and actual treatment strategy. The secondary outcome was two-year vessel-oriented composite endpoint (VOCE), a composite of vessel-related cardiovascular death, vessel-related myocardial infarction, and target vessel revascularization. RESULTS: A total of 441 patients (598 non-culprit vessels) met the inclusion criteria. Median vFFR was 0.85 (0.73-0.91). Revascularization was performed in 34.4% of vessels. Discordance between vFFR and actual treatment strategy occurred in 126 (21.1%) vessels. Freedom from VOCE was higher for concordant vessels (97.5%) as compared to discordant vessels (90.6%)(p = 0.003), particularly due to higher adverse event rates in discordant vessels with a vFFR ≤0.80 but deferred revascularization. CONCLUSIONS: In STEMI patients with multivessel disease, discordance between vFFR reclassification and treatment strategy was observed in 21.1% of non-culprit vessels with an intermediate lesion and was associated with increased vessel-related adverse events.
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Groenland et al. (2022) conducted a cohort in ST-segment elevation myocardial infarction (STEMI) (n=441). Discordance between vFFR reclassification and treatment strategy vs. Concordance between vFFR and treatment strategy was evaluated on Percentage of non-culprit vessels with discordance between vFFR and actual treatment strategy. Discordance between vFFR and treatment strategy occurred in 21.1% of non-culprit vessels and was associated with lower 2-year freedom from VOCE compared to concordance (90.6% vs 97.5%, p=0.003).
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