医学
部分流量储备
心脏病学
经皮冠状动脉介入治疗
内科学
心肌梗塞
ST段
经皮
冠状动脉造影
作者
Pierre Denormandie,Tabassome Simon,Guillaume Cayla,Philippe Gabríel Steg,Gilles Montalescot,Isabelle Durand‐Zaleski,Alicia Le Bras,Hervé Breton,Yann Valy,François Schiele,Thomas Cuisset,Gérald Vanzetto,Sébastien Lévesque,Pascal Goube,O. Nallet,Denis Angoulvant,François Roubille,Anaïs Charles‐Nelson,Gilles Châtellier,Nicolas Danchin,Étienne Puymirat
出处
期刊:Circulation-cardiovascular Interventions
[Ovid Technologies (Wolters Kluwer)]
日期:2021-08-23
卷期号:14 (11)
被引量:26
标识
DOI:10.1161/circinterventions.121.011314
摘要
Background: In patients with ST-segment–elevation myocardial infarction and multivessel disease, percutaneous coronary intervention (PCI) for nonculprit lesions guided by fractional flow reserve (FFR) is superior to treatment of the culprit lesion alone. Whether deferring nonculprit PCI is safe in this specific context is questionable. We aimed to assess clinical outcomes at 1 year in ST-segment–elevation myocardial infarction patients with multivessel coronary artery disease and an FFR-guided strategy for nonculprit lesions, according to whether or not ≥1 PCI was performed. Methods: Outcomes were analyzed in patients of the randomized FLOWER-MI (Flow Evaluation to Guide Revascularization in Multivessel ST-Elevation Myocardial Infarction) trial in whom, after successful primary PCI, nonculprit lesions were assessed using FFR. The primary outcome was a composite of all-cause death, nonfatal myocardial infarction, and unplanned hospitalization with urgent revascularization at 1 year. Results: Among 1171 patients enrolled in this study, 586 were assigned to the FFR-guided group: 388 (66%) of them had ≥1 PCI, and 198 (34%) had no PCI. Mean FFR before decision (ie, PCI or not) of nonculprit lesions was 0.75±0.10 and 0.88±0.06, respectively. During follow-up, a primary outcome event occurred in 16 of 388 patients (4.1%) in patients with PCI and in 16 of 198 patients (8.1%) in patients without PCI (adjusted hazard ratio, 0.42 [95% CI, 0.20–0.88]; P =0.02). Conclusions: In patients with ST-segment–elevation myocardial infarction undergoing complete revascularization guided by FFR measurement, those with ≥1 PCI had lower event rates at 1 year, compared with patients with deferred PCI, suggesting that deferring lesions judged relevant by visual estimation but with FFR >0.80 may not be optimal in this context. Future randomized studies are needed to confirm these data. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT02943954. Graphic Abstract: A graphic abstract is available for this article.
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