Abstract 15023: Fractional Flow Reserve-Guided Complete Revascularization in AMI Patients With Angiographically Severe Non-Culprit Lesion: FRAME-AMI Substudy

Abstract

Background: The benefit of fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI) for non-culprit lesions with angiographically severe stenosis in patients with acute myocardial infarction (AMI) is unclear Objectives We evaluated the relationship between non-culprit lesion stenosis measured by quantitative coronary angiography (QCA) and the efficacy of FFR-guided PCI Methods: Severity of non-culprit lesion stenosis of 562 patients from FRAME-AMI (FFR vs. Angiography-Guided Strategy for Management of Non-Infarction Related Artery Stenosis in Patients with AMI) was measured using QCA in the core laboratory. The effect of FFR-guided versus angiography-guided PCI according to non-culprit lesion stenosis (QCA stenosis ≥70% or <70%) on the primary end point (risk of death, MI or repeat revascularization) was analyzed Results: At a median follow-up of 3.5 years, the primary end point occurred in 14 patients of 181 patients with FFR-guided PCI and 31 of 197 patients with angiography-guided PCI among patient with QCA stenosis ≥70% (7.7% vs 15.7%; hazard ratio, 0.48; 95% confidence interval, 0.25 to 0.90; P=0.022), while occurred in 4 of 103 patients with FFR-guided PCI and 9 of 81 patients with angiography-guided PCI among those with QCA stenosis < 70% (3.9% vs 11.1%, p=0.079). FFR-guided PCI was associated with the reduction of death and myocardial infarction in patients with QCA stenosis ≥70% (6.1% vs 13.7%, p=0.019) and those with QCA stenosis < 70% (1.0% vs 9.9%, p=0.028) compare to angiography-guided PCI Conclusions: In patients with AMI and multivessel disease, patients with severe non-infarct related artery lesion was also benefited by FFR-guided PCI.