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Meta-analysis of fractional flow reserve guided complete revascularization versus infarct related artery only revascularization in patients with ST-elevation myocardial infarction and multivessel coronary artery disease

Neupane, Saroja; Singh, Hemindermeetc; Edla, Sushruthb; Altujjar, Mohammadb; Yamsaki, Hiroshib; Lalonde, Thomasb; Rosman, Howard S.b; Eggebrecht, Holgere; Mehta, Rajendra H.d

doi: 10.1097/MCA.0000000000000740
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Background Multivessel coronary artery disease is found in 30–50% of patients with ST-elevation myocardial infarction (MI) and is associated with adverse outcomes. It is not yet clear if outcomes are improved by utilizing fractional flow reserve (FFR) guided percutaneous coronary intervention (PCI) of noninfarct related artery (non-IRA) along with primary PCI.

Methods and results To evaluate this, we performed a metanalysis of published randomized controlled trials by performing systematic search of PubMed, Medline, Google Scholar and Cochrane Central. Three studies met the inclusion criteria, with total of 1633 patients; 689 underwent FFR-guided complete revascularization and 944 underwent IRA only revascularization. FFR-guided PCI of non-IRA along with primary PCI led to significant reduction of major adverse cardiovascular events (composite of death, MI and repeat revascularization) compared to PCI of IRA only [odds ratio (OR) = 0.55; 95% confidence interval (CI) = 0.42–0.72; P < 0.001]. This difference was primarily due to significant reduction in repeat revascularization (OR = 0.37; 95% CI = 0.26–0.53; P < 0.001). The rates of all-cause mortality (OR = 1.24; 95% CI = 0.65–2.35; P = 0.51) and MI (OR = 0.79; 95% CI = 0.46–1.36; P = 0.48) were similar in two groups.

Conclusion This meta-analysis demonstrated that FFR-guided PCI of non-IRA along with primary PCI was associated with lower rate of major adverse cardiovascular events compared with PCI of IRA-only in patients with ST-elevation MI and multivessel disease. The difference was driven by lower rate of repeat revascularization in FFR-guided PCI of non-IRA group.

This metanalysis was performed to evaluate if outcomes are improved by utilizing fractional flow reserve (FFR) guided percutaneous coronary intervention (PCI) of non-infarct related artery (non-IRA) along with primary PCI. Three studies met the inclusion criteria, with total of 1633 patients; 689 underwent FFR-guided complete revascularization and 944 underwent IRA only revascularization. FFR-guided PCI of non-IRA along with primary PCI led to significant reduction of major adverse cardiovascular events (MACE; composite of death, myocardial infarction and repeat revascularization) compared to PCI of IRA only [OR=0.55 (95% CI=0.42-0.72), p<0.001] This difference was primarily due to significant reduction in repeat revascularization [OR=0.37 ([95% CI=0.26-0.53), p<0.001].

aDepartment of Internal Medicine, Division of Cardiology, Henry Ford Hospital

bDepartment of Internal Medicine, St John Hospital and Medical Center, Detroit, Michigan

cCardiovascular Fellowship Program, Mercy-Health St Vincent Medical Center, Toledo, Ohio

dDuke Clinical Research Institute, Durham, North Carolina, USA

eCardioangiological Center Bethanien (CCB) and AGAPLESION Bethanien Hospital, Frankfurt, Germany

Received 9 September 2018 Revised 8 December 2018 Accepted 1 April 2019

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Correspondence to Saroj Neupane, MD, 2799W Grand Blvd, Detroit, MI 48202, USA, Tel: + 1 313 916 2871; fax: +1 313 916 4489; e-mail: neupane.saroj99@gmail.com

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