Key result
FFR-guided complete revascularisation cuts major events ~54% vs IRA-only treatment.
Why the study?
The Compare-Acute trial previously demonstrated superiority of FFR-guided complete revascularisation over culprit-only treatment at one year in STEMI patients with multivessel disease, but longer-term outcomes and cost benefits were unknown.
Does FFR-guided complete revascularisation reduce the composite of death, myocardial infarction, revascularisation, or stroke in patients with STEMI and multivessel disease compared to IRA-only treatment?
RCT (n=885)
1:2 ratio
Does FFR-guided complete revascularisation reduce the composite of death, myocardial infarction, revascularisation, or stroke in patients with STEMI and multivessel disease compared to IRA-only treatment?
Hazard Ratio: 0.46 (95% CI 0.33–0.64)
Absolute Event Rate: 15.6% vs 30.2%
p-value: p=<0.001
FFR-guided complete revascularization in STEMI patients with multivessel disease significantly reduces long-term adverse events (driven by fewer repeat revascularizations) and lowers healthcare costs at 3 years compared to culprit-only PCI.
Supports FFR-guided complete revascularization in STEMI with multivessel disease; extends randomized evidence for physiology-guided strategies to acute settings.
AIMS: The Compare-Acute trial showed superiority of fractional flow reserve (FFR)-guided acute complete revascularisation compared to culprit-only treatment in patients with ST-segment elevation myocardial infarction (STEMI) and multivessel disease (MVD) at one year. The aim of this study was to investigate the outcome at three years, together with cost analysis of this strategy. METHODS AND RESULTS: After primary percutaneous coronary intervention (PCI), 885 patients with STEMI and MVD were randomised (1:2 ratio) to FFR-guided complete revascularisation (295 patients) or infarct-related artery (IRA)-only treatment (590 patients). After 36 months, the primary endpoint (composite of death, myocardial infarction, revascularisation, stroke) occurred significantly less frequently in the FFR-guided complete revascularisation group: 46/295 patients (15.6%) versus 178/590 patients (30.2%) (HR 0.46, 95% CI: 0.33-0.64; p<0.001). This benefit was driven mainly by the reduction of revascularisations in the follow-up (12.5% vs 25.2%; HR 0.45, 95% CI: 0.31-0.64; p<0.001). Cost analysis shows benefit of the FFR-guided complete revascularisation strategy, which can reduce the cost per patient by up to 21% at one year (8,150€ vs 10,319€) and by 22% at three years (8,653€ vs 11,100€). CONCLUSIONS: In patients with STEMI and MVD, FFR-guided complete revascularisation is more beneficial in terms of outcome and healthcare costs compared to IRA-only revascularisation at 36 months.
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Smits et al. (2020) conducted an RCT in ST-segment elevation myocardial infarction (STEMI) and multivessel disease (MVD) (n=885). FFR-guided complete revascularisation vs. infarct-related artery (IRA)-only treatment was evaluated on composite of death, myocardial infarction, revascularisation, stroke (HR 0.46, 95% CI 0.33-0.64, p=<0.001). FFR-guided complete revascularisation significantly reduced the composite of death, MI, revascularisation, or stroke compared to IRA-only treatment (15.6% vs 30.2%; HR 0.46; 95% CI 0.33-0.64; P<0.001).
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