Key result
FFR-guided complete revascularization reduces MACE ~53% vs culprit-only revascularization in STEMI with multivessel disease.
Why the study?
Approximately 30-50% of STEMI patients have non-infarct-related coronary artery disease associated with worse prognosis, but optimal treatment strategy and timing remain unclear.
Does FFR-guided complete revascularization reduce MACE in patients with STEMI and multi-vessel disease compared to culprit-only revascularization?
Meta-Analysis (n=1,631)
Open-label
Randomized
Yes
Does FFR-guided complete revascularization reduce MACE in patients with STEMI and multi-vessel disease compared to culprit-only revascularization?
Odds Ratio: 0.47 (95% CI 0.35–0.62)
Absolute Event Rate: 13.2% vs 21.5%
p-value: p=<0.00001
In patients with STEMI and multi-vessel disease, FFR-guided complete revascularization significantly reduces MACE and ischemia-driven repeat revascularization compared to culprit-only revascularization, without affecting all-cause mortality.
FFR-guided CR may reduce repeat revascularization versus culprit-only in multivessel disease; leaves open direct comparison with angiography guidance and optimal timing.
BACKGROUND: Approximately 30-50% patients with acute ST-segment elevation myocardial infarction (STMEI) were found to have non-infarct-related coronary artery (IRA) disease, which was significantly associated with worse prognosis. However, challenges still remain for these patients: which non-infarct-related lesion should be treated and when should the procedure be performed? The present study aims to investigate Fractional flow reserve (FFR)-guided complete revascularization (CR) in comparison to culprit-only revascularization (COR) in patients with ST-segment elevation myocardial infarction (STEMI) and multi-vessel disease (MVD). METHODS: Three appropriate randomized controlled trials (RCTs) were selected from the PubMed/Medline, EMBASE, and the Cochrane library /CENTRAL databases. 1631 patients (688 patients underwent FFR-guided CR and 943 patients underwent COR) following-up 12-44 months was evaluated. RESULTS: FFR-guided CR significantly reduced major adverse cardiac event (MACE) (OR 0.47, 95% CI: 0.35-0.62, P < 0.00001) and ischemia-driven repeat revascularization (OR 0.36, 0.26-0.51, P < 0.00001), as compared to COR. However, there is no difference in all-cause mortality (OR 1.24, 0.65-2.35, P = 0.51). CONCLUSIONS: In patients with STEMI and MVD, FFR-guided CR is better than COR in terms of MACE and ischemia-driven repeat revascularization, while there are almost similar in all-cause mortality. TRIAL REGISTRATION: All analyses were based on previous published studies, thus no ethical approval and patient consent are required COMPARE-ACUTE trial number NCT01399736 ; DANAMI-3-PRIMULTI trial number NCT01960933 .
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Wang et al. (2019) conducted a meta-analysis in Acute ST-segment elevation myocardial infarction (STEMI) and multi-vessel disease (n=1,631). Fractional flow reserve (FFR)-guided complete revascularization vs. Culprit-only revascularization was evaluated on Major adverse cardiovascular events (MACE) (OR 0.47, 95% CI 0.35-0.62, p=<0.00001). Fractional flow reserve-guided complete revascularization significantly reduced major adverse cardiac events (OR 0.47) compared to culprit-only revascularization in patients with STEMI and multi-vessel disease.
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