Fractional Flow Reserve–Guided Multivessel Angioplasty in Myocardial Infarction

Abstract

In patients with STEMI and multivessel disease who underwent primary PCI of an infarct-related artery, the addition of FFR-guided complete revascularization of non-infarct-related arteries in the acute setting resulted in a risk of a composite cardiovascular outcome that was lower than the risk among those who were treated for the infarct-related artery only. This finding was mainly supported by a reduction in subsequent revascularizations. (Funded by Maasstad Cardiovascular Research and others; Compare-Acute ClinicalTrials.gov number, NCT01399736 .).

Impact of Routine Fractional Flow Reserve on Management Decision and 1-Year Clinical Outcome of Patients With Acute Coronary Syndromes

“…22 Overall, our results reinforce the potential role of FFR in this setting and demonstrate that in patients diagnosed with an ACS, in whom operators feel that FFR is appropriate for decision making, an FFR value of >0.80 in all investigated lesions reliably identifies a group of patients at a lower risk of events (when compared to those were PCI or CABG is deemed necessary by FFR) and indicates that revascularization can be safely deferred ( Figure 5; Table 5). …”

Najnowsze doniesienia kardiologiczne znad Potomaku — relacja z kongresu American College of Cardiology Waszyngton, 17–19 marca 2017

“…Wyniki te są zgodne z uzyskanymi we wcześniejszych badaniach, w których wskazywano na korzyści wynikające z bardziej kompleksowego podejścia do leczenia STEMI, ale jest to pierwsze randomizowane badanie kliniczne, w którym używano FFR, by precyzyjnie ocenić istotność zwężenia w pozostałych naczyniach wieńcowych. Mimo obaw o zwiększenie złożoności procedury służącej leczeniu zawału serca okazało się, że procedury w grupie poddanej całkowitej rewaskularyzacji były średnio tylko o 6 min dłuższe niż w grupie poddanej rewaskularyzacji ograniczonej do IRA [5]. Co ciekawe, wzrokowo oceniane zwężenia co najmniej 50% średnicy naczynia wykazywały istotnie obniżoną FFR w około połowie, co potwierdza nieadekwatność luminogramu jako jedynej podstawy wyboru naczynia do angioplastyki.…”

Report of the Annual Scientific Sessions of the American College of Cardiology (ACC), Washington DC

“…However, the use of PCI in non-infarct-related coronary arteries remains controversial. Methods Pieter Smits demonstrated the data from the COMPARE-ACUTE study, 6 which randomly assigned 885 patients with STEMI and multivessel disease who had undergone primary PCI of an infarct-related coronary artery in a 1:2 ratio to undergo complete revascularization of non-infarct-related coronary arteries guided by fractional flow reserve (FFR) or to undergo no revascularization of non-infarct-related coronary arteries. The primary endpoint was a composite of any-cause death, nonfatal MI, revascularization, and cerebrovascular events at 12 months.…”