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Angiographic Severity of the Nonculprit Lesion and the Efficacy of Fractional Flow Reserve-Guided Complete Revascularization in Patients With AMI: FRAME-AMI Substudy.

Authors :
Seung J
Choo EH
Kim CJ
Kim HK
Park KH
Lee SH
Kim MC
Hong YJ
Ahn SG
Doh JH
Lee SY
Park SD
Lee HJ
Kang MG
Koh JS
Cho YK
Nam CW
Koo BK
Lee BK
Yun KH
Hong D
Joh HS
Choi KH
Park TK
Lee JM
Yang JH
Song YB
Choi SH
Gwon HC
Hahn JY
Source :
Circulation. Cardiovascular interventions [Circ Cardiovasc Interv] 2024 Jan; Vol. 17 (1), pp. e013611. Date of Electronic Publication: 2023 Nov 06.
Publication Year :
2024

Abstract

Background: The benefit of fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI) for noninfarct-related artery (IRA) lesions with angiographically severe stenosis in patients with acute myocardial infarction is unclear.<br />Methods: Among 562 patients from the FRAME-AMI trial (Fractional Flow Reserve Versus Angiography-Guided Strategy for Management of Non-Infraction Related Artery Stenosis in Patients With Acute Myocardial Infarction) who were randomly allocated into either FFR-guided or angiography-guided PCI for non-IRA lesions, the current study evaluated the relationship between non-IRA stenosis measured by quantitative coronary angiography (QCA) and the efficacy of FFR-guided PCI. The incidence of the primary end point (death, myocardial infarction, or repeat revascularization) was compared between FFR- and angiography-guided PCI according to non-IRA stenosis severity (QCA stenosis ≥70% or <70%).<br />Results: A total of 562 patients were assigned to FFR-guided (n=284) versus angiography-guided PCI (n=278). At a median follow-up of 3.5 years, the primary end point occurred in 14 of 181 patients with FFR-guided PCI and 31 of 197 patients with angiography-guided PCI among patients with QCA stenosis ≥70% (8.5% versus 19.2%; hazard ratio, 0.41 [95% CI, 0.22-0.80]; P =0.008), while occurred in 4 of 103 patients with FFR-guided PCI and 9 of 81 patients with angiography-guided PCI among those with QCA stenosis <70% (3.9% versus 11.1%; P =0.315). There was no significant interaction between treatment strategy and non-IRA stenosis severity ( P for interaction=0.636). FFR-guided PCI was associated with the reduction of death and myocardial infarction in both patients with QCA stenosis ≥70% (6.7% versus 15.1%; P =0.008) and those with QCA stenosis <70% (1.0% versus 9.6%; P =0.042) compared with angiography-guided PCI.<br />Conclusions: In patients with acute myocardial infarction and multivessel disease, FFR-guided PCI tended to have a lower risk of primary end point than angiography-guided PCI regardless of non-IRA stenosis severity without significant interaction.<br />Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT02715518.<br />Competing Interests: Disclosures Dr Hahn received an Institutional Research Grant from National Evidence-Based Healthcare Collaborating Agency, Ministry of Health and Welfare, Republic of Korea, Abbott Vascular, Biosensors, Boston Scientific, Daiichi Sankyo, Donga-ST, and Medtronic, Inc. Dr Lee received an Institutional Research Grant from Abbott Vascular, Boston Scientific, Philips Volcano, Terumo Corporation, Donga-ST, Zoll Medical, and Yuhan Pharmaceutical. Dr Gwon received an Institutional Research Grant from Abbott Vascular, Boston Scientific, and Medtronic, Inc. The other authors report no conflicts.

Details

Language :
English
ISSN :
1941-7632
Volume :
17
Issue :
1
Database :
MEDLINE
Journal :
Circulation. Cardiovascular interventions
Publication Type :
Academic Journal
Accession number :
37929584
Full Text :
https://doi.org/10.1161/CIRCINTERVENTIONS.123.013611