Abstract 15373: Guiding Modalities for Non-Culprit Artery Revascularization in Acute Myocardial Infarction With Multivessel Disease: A Pooled Analysis of FLOWER-MI and FRAME-AMI

Abstract

Background: Currently, it is not yet clear whether angiography or fractional flow reserve (FFR) is better in guiding percutaneous coronary intervention (PCI) for non-culprit artery revascularization in patients with acute myocardial infarction (AMI) and multivessel disease (MVD) after primary PCI. Therefore, a pooled analysis is conducted to summarize the findings from two only available trials, i.e., FRAME-AMI and FLOWER-MI. Aim: To compare major cardiac adverse event (MACE) between angiography-guided and FFR-guided non-culprit artery revascularization in AMI and MVD Method: MACE defined as a primary endpoint of all-cause death, non-fatal myocardial infarction, or unplanned revascularization was the primary outcome while all-cause death was the secondary outcome. Pooled cumulative probability of developing the primary endpoint curves were constructed from extracted Kaplan-Meier curves using Weibull distribution, and a meta-analysis was performed to pool extracted hazard ratio (HR) and 95% confidence intervals (CI). Furthermore, a subgroup analysis of STEMI and NSTEMI groups was performed. Result: Cumulative probability curve is displayed in Figure 1A. A pooled analysis showed no difference between two guiding modalities both in MACE and all-cause death risk reduction. FFR-guided PCI reduced MACE risk by 24% (HR 0.76, 95% CI 0.25-2.27) and risk of all-cause death by 47% (HR 0.53, 95% CI 0.18-1.54) compared to angiography-guided PCI but not statistically significant as shown in Figure 1B. Regarding subgroup analysis concerning MACE, FFR-guided PCI was not superior to angiography-guided PCI in STEMI (HR 1.06, 95% CI 0.60-1.90) despite significantly superior to angiography-guided PCI in FRAME-AMI NSTEMI group. Conclusion: FFR-guided PCI is not superior to angiography-guided PCI in non-culprit artery revascularization in AMI and MVD concerning risk reduction of MACE and all-cause death, but might show superiority in the NSTEMI subgroup.