Abstract
BackgroundApproximately 30–50% patients with acute ST-segment elevation myocardial infarction (STMEI) were found to have non-infarct-related coronary artery (IRA) disease, which was significantly associated with worse prognosis. However, challenges still remain for these patients: which non-infarct-related lesion should be treated and when should the procedure be performed? The present study aims to investigate Fractional flow reserve (FFR)-guided complete revascularization (CR) in comparison to culprit-only revascularization (COR) in patients with ST-segment elevation myocardial infarction (STEMI) and multi-vessel disease (MVD).MethodsThree appropriate randomized controlled trials (RCTs) were selected from the PubMed/Medline, EMBASE, and the Cochrane library /CENTRAL databases. 1631 patients (688 patients underwent FFR-guided CR and 943 patients underwent COR) following-up 12–44 months was evaluated.ResultsFFR-guided CR significantly reduced major adverse cardiac event (MACE) (OR 0.47, 95% CI: 0.35–0.62, P < 0.00001) and ischemia-driven repeat revascularization (OR 0.36, 0.26–0.51, P < 0.00001), as compared to COR. However, there is no difference in all-cause mortality (OR 1.24, 0.65–2.35, P = 0.51).ConclusionsIn patients with STEMI and MVD, FFR-guided CR is better than COR in terms of MACE and ischemia-driven repeat revascularization, while there are almost similar in all-cause mortality.Trial registrationAll analyses were based on previous published studies, thus no ethical approval and patient consent are required COMPARE-ACUTE trial number NCT01399736; DANAMI-3–PRIMULTI trial number NCT01960933.
Highlights
30–50% patients with acute ST-segment elevation myocardial infarction (STMEI) were found to have non-infarct-related coronary artery (IRA) disease, which was significantly associated with worse prognosis
Challenges still remain for these patients: which non-infarct-related lesion should be treated and when should the procedure be performed? Previously, many STsegment elevation myocardial infarction (STEMI) guidelines from AHA/ACC/ ESC didn’t recommend to offer complete revascularization for STEMI patients with multi-vessel disease during primary percutaneous coronary intervention (PCI) without hemodynamic instability, which could increase the rate of mortality [3,4,5]. 2015 ACC/AHA guideline declared IIb recommendation for complete revascularization in selected STEMI patients with multi-vessel disease
This recommendation was based on the data from PRAMI, DANAMI3-PRIMULTI, CVLPRIT and COMPARE-ACUTE trials, which favored the reductions in the risk of major adverse cardiovascular event (MACE) and repeat revascularization, not in all-cause or cardiovascular mortality rate
Summary
30–50% patients with acute ST-segment elevation myocardial infarction (STMEI) were found to have non-infarct-related coronary artery (IRA) disease, which was significantly associated with worse prognosis. 2015 ACC/AHA guideline declared IIb recommendation for complete revascularization in selected STEMI patients with multi-vessel disease For these patients, the updated 2017 ESC STEMI management guideline recommended complete revascularization that noninfarcted related artery lesion should be treated during either index procedure or index admission, following culprit lesion revascularization. This recommendation was based on the data from PRAMI, DANAMI3-PRIMULTI, CVLPRIT and COMPARE-ACUTE trials, which favored the reductions in the risk of major adverse cardiovascular event (MACE) and repeat revascularization, not in all-cause or cardiovascular mortality rate. We aimed to investigate whether FFRguided functionally complete revascularization with PCI in patients with STEMI and multi-vessel disease could further improve the prognosis, especially the hard end point
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