Key result
FFR-guided complete revascularization reduces MACE ~34% versus culprit-only revascularization.
Why the study?
Among STEMI patients with multivessel disease, it is unclear whether FFR-guided complete revascularization is superior to culprit-only revascularization.
Does FFR-guided complete revascularization reduce major adverse cardiac events in STEMI patients with multivessel disease compared to culprit-only revascularization?
Meta-Analysis (n=3,482)
Does FFR-guided complete revascularization reduce major adverse cardiac events in STEMI patients with multivessel disease compared to culprit-only revascularization?
Relative Risk: 0.66 (95% CI 0.46–0.94)
In STEMI patients with multivessel disease, FFR-guided complete revascularization significantly reduces major adverse cardiac events and repeat revascularizations compared to culprit-only revascularization, without affecting all-cause mortality.
Supports FFR-guided complete revascularization in STEMI with multivessel disease; confirms MACE reduction in meta-analysis of trials.
Background: Among patients with ST-elevation myocardial infarction (STEMI) and multivessel disease, whether fractional flow reserve (FFR) guided complete revascularization (CR) is superior to the now widely used culprit-only (COR) revascularization is unclear. Methods: We conducted a search of PubMed, Embase, the Cochrane Library, and CNKI for randomized controlled trials comparing FFR-guided CR with COR in STEMI patients with multivessel disease. Data extraction and analysis adhered to Cochrane guidelines, with major adverse cardiac events as the primary outcome. Results: This meta-analysis included 6 trials involving 3,482 patients. FFR-guided CR was associated with a reduction in major adverse cardiac events (RR: 0.66, 95% CI: 0.46-0.94, 95% PI: 0.20-2.19), ischemia-driven revascularization (RR: 0.27, 95% CI: 0.19-0.40, 95% PI: 0.16-0.46), and repeat percutaneous coronary interventions (RR: 0.35, 95% CI: 0.22-0.50, 95% PI: 0.16-0.78) compared to COR. However, no difference was observed in all-cause mortality (RR: 1.12, 95% CI: 0.86-1.46, 95% PI: 0.79-1.58) or safety outcomes. Conclusion: FFR-guided CR reduces major adverse cardiac events compared to COR, though benefits may vary across settings. It significantly lowers ischemia-driven revascularization and repeat percutaneous coronary interventions, with no difference in all-cause mortality compared to COR. Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD42024567524, PROSPERO (CRD42024567524).
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Yang et al. (2025) conducted a meta-analysis in ST-elevation myocardial infarction (STEMI) with multivessel disease (n=3,482). Fractional flow reserve (FFR)-guided complete revascularization vs. Culprit-only revascularization (COR) was evaluated on Major adverse cardiac events (RR 0.66, 95% CI 0.46-0.94). Fractional flow reserve-guided complete revascularization reduced major adverse cardiac events compared to culprit-only revascularization (RR 0.66; 95% CI 0.46-0.94).
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