FFR- Versus Angiography-Guided Revascularization for Nonculprit Stenosis in STEMI and Multivessel Disease

Elbadawi, Ayman; Dang, Alexander; Hamed, Mohamed; Eid, Mennaallah; Prakash, Meghana Prakash Hiriyur; Saleh, Mohammed; Gad, Mohamed M.; Mamas, Mamas A.; Rahman, Faisal; Elgendy, Islam Y.

doi:10.1016/j.jcin.2022.01.002

Cited by 26 publications

(7 citation statements)

References 29 publications

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“…At 1 year, the primary outcome event of a composite of death, MI, or unplanned urgent revascularization occurred in 5.5% and 4.2% in the FFR- and angiography-guided groups ( p = 0.31), failing to demonstrate the superiority of FFR guidance [ 27 ]. Meta-analyses following the publication of COMPLETE and FLOWER-MI trials demonstrated no superiority of FFR guidance over angiography alone when performing complete revascularization, and even angiographic guidance was non-significantly associated with a lower risk of unplanned revascularization in patients with STEMI and MV CAD [ 28 , 29 ]. Given that FFR often underestimate the severity of non-culprit lesions in an acute setting of STEMI [ 26 ], underutilization of angiographically complete revascularization may deteriorate the prognosis.…”

Section: Introductionmentioning

confidence: 99%

Complete revascularization in acute myocardial infarction: a clinical review

Saito

Kobayashi

2023

Cardiovasc Interv and Ther

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In patients with ST segment elevation and non-ST elevation myocardial infarction (MI), multivessel (MV) coronary artery disease is found in approximately 50%, leading to worse clinical outcomes. Recent data have suggested that complete revascularization with MV percutaneous coronary intervention is associated with a reduced risk of major adverse cardiovascular events as compared to culprit vessel-only revascularization. However, the optimal timing of MV intervention, appropriate non-culprit lesion assessment, and the best revascularization strategy in specific subsets such as cardiogenic shock remain to be established. This review article summarizes current evidence on revascularization strategies in patients with acute MI and MV disease.

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Section: Introductionmentioning

confidence: 99%

Complete revascularization in acute myocardial infarction: a clinical review

Saito

Kobayashi

2023

Cardiovasc Interv and Ther

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“…Additionally, the included RCTs in the current analysis included variable proportion of patients with ACS. Several uncertainties have been raised regarding the safety and efficacy of FFR in deferring revascularisation among acutely ill patients, including those with ACS 24. Certain physiological changes among patients with ACS might preclude maximal microvascular dilatation, which is required for recording reliable FFR values 25.…”

Section: Discussionmentioning

confidence: 99%

Fractional flow reserve versus angiography alone in guiding myocardial revascularisation: a systematic review and meta-analysis of randomised trials

Elbadawi

Sedhom

Dang

et al. 2022

Heart

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BackgroundRandomised trials evaluating the efficacy and safety of fractional flow reserve (FFR)-guided versus angiography-guided revascularisation among patients with obstructive coronary artery disease (CAD) have yielded mixed results.AimsTo examine the comparative efficacy and safety of FFR-guided versus angiography-guided revascularisation among patients with obstructive CAD.MethodsAn electronic search of MEDLINE, SCOPUS and Cochrane databases without language restrictions was performed through November 2021 for randomised controlled trials that evaluated the outcomes of FFR-guided versus angiography-guided revascularisation. The primary outcome was major adverse cardiac events (MACE). Data were pooled using a random-effects model.ResultsThe final analysis included seven trials with 5094 patients. The weighted mean follow-up duration was 38 months. Compared with angiography guidance, FFR guidance was associated with fewer number of stents during revascularisation (standardised mean difference=−0.80; 95% CI −1.33 to −0.27), but no difference in total hospital cost. There was no difference between FFR-guided and angiography-guided revascularisation in long-term MACE (13.6% vs 13.9%; risk ratio (RR) 0.97, 95% CI 0.85 to 1.11). Meta-regression analyses did not reveal any evidence of effect modification for MACE with acute coronary syndrome (p=0.36), proportion of three-vessel disease (p=0.88) or left main disease (p=0.50). There were no differences between FFR-guided and angiography-guided revascularisation in the outcomes all-cause mortality (RR 1.16, 95% CI 0.80 to 1.68), cardiovascular mortality (RR 1.27, 95% CI 0.50 to 3.26), repeat revascularisation (RR 0.99, 95% CI 0.81 to 1.21), recurrent myocardial infarction (RR 0.92, 95% CI 0.74 to 1.14) or stent thrombosis (RR 0.61, 95% CI 0.31 to 1.21).ConclusionAmong patients with obstructive CAD, FFR-guided revascularisation did not reduce the risk of long-term adverse cardiac events or the individual outcomes. However, FFR-guided revascularisation was associated with fewer number of stents.PROSPERO registration numberCRD42021291596.

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“…The authors demonstrated that an FFR-guided strategy had no significant advantage over an angiography-guided strategy with respect to the primary endpoint (composite of death, MI, and urgent revascularization at 1 year) [ 121 ]. More recently, a comprehensive network meta-analysis of 11 RCTs comparing FFR and angiography in this setting concluded that complete revascularization of non-culprit stenosis was associated with a lower incidence of adverse events compared with culprit-only revascularization, but FFR guidance was not superior to angiography guidance in reducing MACE [ 122 ].…”

Section: Revascularization Strategymentioning

confidence: 99%

Management of Residual Risk in Chronic Coronary Syndromes. Clinical Pathways for a Quality-Based Secondary Prevention

Giubilato,

Lucà,

Abrignani

et al. 2023

JCM

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Chronic coronary syndrome (CCS), which encompasses a broad spectrum of clinical presentations of coronary artery disease (CAD), is the leading cause of morbidity and mortality worldwide. Recent guidelines for the management of CCS emphasize the dynamic nature of the CAD process, replacing the term “stable” with “chronic”, as this disease is never truly “stable”. Despite significant advances in the treatment of CAD, patients with CCS remain at an elevated risk of major cardiovascular events (MACE) due to the so-called residual cardiovascular risk. Several pathogenetic pathways (thrombotic, inflammatory, metabolic, and procedural) may distinctly contribute to the residual risk in individual patients and represent a potential target for newer preventive treatments. Identifying the level and type of residual cardiovascular risk is essential for selecting the most appropriate diagnostic tests and follow-up procedures. In addition, new management strategies and healthcare models could further support available treatments and lead to important prognostic benefits. This review aims to provide an overview of the diagnostic and therapeutic challenges in the management of patients with CCS and to promote more effective multidisciplinary care.

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FFR- Versus Angiography-Guided Revascularization for Nonculprit Stenosis in STEMI and Multivessel Disease

Cited by 26 publications

References 29 publications

Complete revascularization in acute myocardial infarction: a clinical review

Complete revascularization in acute myocardial infarction: a clinical review

Fractional flow reserve versus angiography alone in guiding myocardial revascularisation: a systematic review and meta-analysis of randomised trials

Management of Residual Risk in Chronic Coronary Syndromes. Clinical Pathways for a Quality-Based Secondary Prevention

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