TY - JOUR
T1 - FFR-Guided Complete or Culprit-Only PCI in Patients with Myocardial Infarction
AU - Böhm, Felix
AU - Mogensen, Brynjölfur
AU - Engstrøm, Thomas
AU - Stankovic, Goran
AU - Srdanovic, Ilija
AU - Lønborg, Jacob
AU - Zwackman, Sammy
AU - Hamid, Mehmet
AU - Kellerth, Thomas
AU - Lauermann, Jörg
AU - Kajander, Olli A
AU - Andersson, Jonas
AU - Linder, Rikard
AU - Angerås, Oskar
AU - Renlund, Henrik
AU - Ērglis, Andrejs
AU - Menon, Madhav
AU - Schultz, Carl
AU - Laine, Mika
AU - Held, Claes
AU - Rück, Andreas
AU - Östlund, Ollie
AU - James, Stefan
AU - FULL REVASC Trial Investigators.
N1 - Copyright © 2024 Massachusetts Medical Society.
PY - 2024/4/25
Y1 - 2024/4/25
N2 - BACKGROUND: The benefit of fractional flow reserve (FFR)-guided complete revascularization in patients with ST-segment elevation myocardial infarction (STEMI) and multivessel coronary artery disease remains unclear.METHODS: In this multinational, registry-based, randomized trial, we assigned patients with STEMI or very-high-risk non-STEMI (NSTEMI) and multivessel disease who were undergoing primary percutaneous coronary intervention (PCI) of the culprit lesion to receive either FFR-guided complete revascularization of nonculprit lesions or no further revascularization. The primary outcome was a composite of death from any cause, myocardial infarction, or unplanned revascularization. The two key secondary outcomes were a composite of death from any cause or myocardial infarction and unplanned revascularization.RESULTS: A total of 1542 patients underwent randomization, with 764 assigned to receive FFR-guided complete revascularization and 778 assigned to receive culprit-lesion-only PCI. At a median follow-up of 4.8 years (interquartile range, 4.3 to 5.2), a primary-outcome event had occurred in 145 patients (19.0%) in the complete-revascularization group and in 159 patients (20.4%) in the culprit-lesion-only group (hazard ratio, 0.93; 95% confidence interval [CI], 0.74 to 1.17; P = 0.53). With respect to the secondary outcomes, no apparent between-group differences were observed in the composite of death from any cause or myocardial infarction (hazard ratio, 1.12; 95% CI, 0.87 to 1.44) or unplanned revascularization (hazard ratio, 0.76; 95% CI, 0.56 to 1.04). There were no apparent between-group differences in safety outcomes.CONCLUSIONS: Among patients with STEMI or very-high-risk NSTEMI and multivessel coronary artery disease, FFR-guided complete revascularization was not shown to result in a lower risk of a composite of death from any cause, myocardial infarction, or unplanned revascularization than culprit-lesion-only PCI at 4.8 years. (Funded by the Swedish Research Council and others; FULL REVASC ClinicalTrials.gov number, NCT02862119.).
AB - BACKGROUND: The benefit of fractional flow reserve (FFR)-guided complete revascularization in patients with ST-segment elevation myocardial infarction (STEMI) and multivessel coronary artery disease remains unclear.METHODS: In this multinational, registry-based, randomized trial, we assigned patients with STEMI or very-high-risk non-STEMI (NSTEMI) and multivessel disease who were undergoing primary percutaneous coronary intervention (PCI) of the culprit lesion to receive either FFR-guided complete revascularization of nonculprit lesions or no further revascularization. The primary outcome was a composite of death from any cause, myocardial infarction, or unplanned revascularization. The two key secondary outcomes were a composite of death from any cause or myocardial infarction and unplanned revascularization.RESULTS: A total of 1542 patients underwent randomization, with 764 assigned to receive FFR-guided complete revascularization and 778 assigned to receive culprit-lesion-only PCI. At a median follow-up of 4.8 years (interquartile range, 4.3 to 5.2), a primary-outcome event had occurred in 145 patients (19.0%) in the complete-revascularization group and in 159 patients (20.4%) in the culprit-lesion-only group (hazard ratio, 0.93; 95% confidence interval [CI], 0.74 to 1.17; P = 0.53). With respect to the secondary outcomes, no apparent between-group differences were observed in the composite of death from any cause or myocardial infarction (hazard ratio, 1.12; 95% CI, 0.87 to 1.44) or unplanned revascularization (hazard ratio, 0.76; 95% CI, 0.56 to 1.04). There were no apparent between-group differences in safety outcomes.CONCLUSIONS: Among patients with STEMI or very-high-risk NSTEMI and multivessel coronary artery disease, FFR-guided complete revascularization was not shown to result in a lower risk of a composite of death from any cause, myocardial infarction, or unplanned revascularization than culprit-lesion-only PCI at 4.8 years. (Funded by the Swedish Research Council and others; FULL REVASC ClinicalTrials.gov number, NCT02862119.).
KW - Aged
KW - Australasia
KW - Coronary Artery Disease/complications
KW - Coronary Vessels/diagnostic imaging
KW - Europe
KW - Female
KW - Follow-Up Studies
KW - Fractional Flow Reserve, Myocardial
KW - Humans
KW - Kaplan-Meier Estimate
KW - Male
KW - Middle Aged
KW - Myocardial Infarction/mortality
KW - Myocardial Revascularization/methods
KW - Percutaneous Coronary Intervention/methods
KW - Registries
KW - Reoperation
KW - ST Elevation Myocardial Infarction/etiology
UR - http://www.scopus.com/inward/record.url?scp=85191616798&partnerID=8YFLogxK
U2 - 10.1056/NEJMoa2314149
DO - 10.1056/NEJMoa2314149
M3 - Journal article
C2 - 38587995
SN - 0028-4793
VL - 390
SP - 1481
EP - 1492
JO - The New England journal of medicine
JF - The New England journal of medicine
IS - 16
ER -