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

Abstract

Background : The benefit of fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI) for non-infarct related artery (IRA) lesions with angiographically severe stenosis in patients with acute myocardial infarction (MI) is unclear. Methods: Among 562 patients from FRAME-AMI trial 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 endpoint (death, MI, or repeat revascularization) was compared between FFR- and angiography-guided PCI according to non-IRA stenosis severity (QCA stenosis ≥70% or <70%). 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 endpoint occurred in 14 patients 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% confidence interval 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% vs. 15.1%, p=0.008) and those with QCA stenosis <70% (1.0% vs. 9.6%, p=0.042) compared to angiography-guided PCI. Conclusions: In patients with acute MI and multivessel disease, FFR-guided PCI tended to have a lower risk of primary endpoint than angiography-guided PCI regardless of non-IRA stenosis severity without significant interaction.

Revascularization Strategy in Myocardial Infarction with Multivessel Disease

“…However, the results of this trial should be interpreted with caution due to premature study termination as a result of slow recruitment, with only 562 of the initially planned 1292 patients randomized. A substudy further revealed that the treatment effect on the primary endpoint was not modified by the severity of the stenoses, determined by quantitative coronary angiography (QCA) [16].…”