Prognosis after non-infarct related artery PCI in patients with acute myocardial infarction and multivessel disease: substudy of FRAME-AMI trial

Abstract

Abstract Background Complete revascularization either angiography-guided or fractional flow reserve (FFR)-guided can improve the clinical outcomes in patients with acute myocardial infarction (AMI) and multivessel disease. However, there is concern that angiography-guided percutaneous coronary intervention (PCI) may result in unnecessary PCI of non-infarct related artery (IRA) and its long-term prognosis is still unclear. Purpose We sought to evaluate clinical outcomes after non-IRA PCI according to quantitative flow ratio (QFR). Methods We performed post-hoc QFR analysis of non-IRA lesions of AMI patients who enrolled in the FRAME-AMI trial which randomly allocated patients into either FFR-guided PCI (FFR≤0.80) or angiography-guided PCI (diameter stenosis of >50%) for non-IRA lesions. Patients were classified by non-IRA QFR values into the QFR≤0.80 and QFR>0.80 groups. The primary end point was a major adverse cardiac event (MACE), a composite of cardiac death, MI, and repeat revascularization. Results A total of 443 patients (552 lesions) were eligible for the QFR analysis. Of 209 patients in the angiography-guided PCI group, 30.0% (N=60) underwent non-IRA PCI despite having QFR>0.80 in non-IRA. Conversely, only 2.7% (N=4) among 209 patients in the FFR-guided PCI group had QFR>0.80 in non-IRA. At a median follow-up of 3.5 years (interquartile range 2.7 to 4.1 years), the rate of MACE was significantly higher among patients with non-IRA PCI despite QFR>0.80 than patients with deferred PCI for non-IRA lesions (12.9% vs. 3.1%; HR=4.13, 95% CI 1.10-15.57, P=0.036). Non-IRA PCI despite QFR>0.80 was associated with higher risk of non-IRA MACE than patients with deferred PCI for non-IRA lesions (12.9% vs. 2.1%; HR 5.44, 95% CI 1.13-26.19, P=0.035). Conclusions In AMI patients with multivessel disease, 30.0% of angiography-guided PCI resulted in unnecessary PCI for non-IRA with QFR>0.80, which was significantly associated with the increased risk of MACE than those with deferred PCI for non-IRA lesions.