TCT-106 FFR in Nonculprits in STEMI: A Substudy of the COMPARE-ACUTE Trial

Piróth, Zsolt; Ömerovic, Elmir; Klerk, Bianca Boxma–de; Abdel‐Wahab, Mohamed; Neumann, Franz‐Josef; Richardt, Gert; Smits, Pieter C.

doi:10.1016/j.jacc.2019.08.152

Cited by 6 publications

(5 citation statements)

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“…FLOWER-MI does not allow us to attribute events to culprit or non-culprit lesions (deferred by FFR or otherwise) but vessel level outcomes were reported in a sub study of Compare-Acute, which had the benefit of measuring non-culprit FFR in both arms. 9 In this study, non-culprit, angiographically insignificant vessels (that did not warrant FFR measurement in the first place) were responsible for two thirds of the spontaneous MIs within the follow-up period.…”

Section: Why Do Patients Have Adverse Events After Culprit Revascularisation?mentioning

confidence: 60%

FLOWER-MI and the root of the problem with non-culprit revascularisation

Silva

Collet

et al. 2021

Open Heart

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How do we reduce cardiac death and myocardial infarction by percutaneous coronary intervention (PCI) in coronary heart disease? Although the interventional community continues to grapple with this question in stable angina, the benefits of PCI for non-culprit lesions found at ST-elevation myocardial infarction are established. Is it then wishful thinking that an index developed in stable coronary disease, for identifying lesions capable of causing ischaemia will show an incremental benefit over angiographically guided non-culprit PCI? This is the question posed by the recently published FLOW Evaluation to Guide Revascularization in Multi-vessel ST-elevation Myocardial Infarction (FLOWER-MI) trial. We examine the trial design and results; ask if there is any relationship between the baseline physiological significance of a non-culprit lesion and vulnerability to future myocardial infarction; and consider if more sophisticated methods can help guide or defer non-culprit revascularisation.

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Section: Why Do Patients Have Adverse Events After Culprit Revascularisation?mentioning

confidence: 60%

FLOWER-MI and the root of the problem with non-culprit revascularisation

Silva

Collet

et al. 2021

Open Heart

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“…Regarding the risk of future myocardial infarctions (MI), it has been proven that patients with FFR-positive lesions show higher levels of serum-oxidated low-density lipoprotein and secretory phospholipase A2, which may be associated with an increased risk of atherosclerotic plaque destabilization [ 48 ]. The association between FFR-positive lesions and MI has been further confirmed in a recent sub-study of the Compare Acute trial by Piròth et al [ 49 ]. In this study involving patients with ST-elevation MI (STEMI) and multivessel disease, the authors demonstrated that non-infarct-related FFR-positive lesions that were not treated with a PCI had a higher risk of generating MIs during a two-year follow-up.…”

Section: The Relationship Between Ffr and Clinical Outcomesmentioning

confidence: 61%

Fractional Flow Reserve-Guided Coronary Revascularization: Evidence from Randomized and Non-Randomized Studies

et al. 2022

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Simple visual estimation of coronary angiography is limited by several factors that can hinder the proper classification of coronary lesions. Fractional flow reserve (FFR) is the most widely used tool to perform a physiological evaluation of coronary stenoses. Compared to isolated angiography, FFR has been demonstrated to be more effective in selecting those lesions associated with myocardial ischemia and, accordingly, impaired outcomes. At the same time, deferring coronary intervention in those lesions that do not show ischemic FFR values has proven safe and not associated with adverse events. Despite a major randomized clinical trial (RCT) and several non-randomized studies showing that FFR-guided revascularization could be superior to isolated angiography in improving clinical outcomes, subsequent RCTs have reported conflicting results. In this review, we summarize the principles behind FFR and the data currently available in the literature, highlighting the main differences between randomized and non-randomized studies that investigated this topic.

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“…Similar studies to the factors of the follow-up period involved only major adverse cardiovascular events (MACE) or physiology-guided coronary lesion revascularizations [34,35]. However, in this study, all patients were followed up for 12 months and used the Seattle angina questionnaire to objectivize the class of physical limitations.…”

Section: Discussionmentioning

confidence: 99%

Quantitative flow ratio vs. angiography- only guided PCI in STEMI patients: a one- year outcomes

Barauskas

Žiubrytė

Jodka

et al. 2022

Preprint

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BackgroundCoronary physiology-guided PCIs are recommended worldwide. However, invasive coronary physiology methods prolong the procedure, make additional risks for the patients, and prolong the uoroscopy time for an interventional cardiologist. Otherwise, there is a non-invasive coronary physiology evaluation method QFR, which can be safely used even in STEMI patients. Methods 198 patients admitted with STEMI and at least one intermediate (35-75%) diameter stenosis other than culprit artery between July 2020 and June 2021 have been prospectively included in this single-centre study. All patients were randomized into one of two groups (1 -QFR-guided PCI; 2 -visual-estimation-only guided PCI). A 12-month follow-up with echocardiography, exercise stress test, and quality of life evaluation was performed in all included patients. For the QOF evaluation, the Seattle angina score questionnaire was chosen. Statistical analysis was performed using Kolmogorov-Smirnov, Stjudent T, Mann-Whitney, Pearson Chi-square tests and Kaplan Meier survival analysis.Results 98 (49.5%) patients were randomized to the rst group, and 100 (50.5%) patients were included in the second group. Statistically, signi cantly more patients had a medical history of dyslipidaemia (98 vs 91, p = 0.002) and slightly better left ventricular ejection fraction (42.21 ± 7.88 vs 39.45 ± 9.62, p = 0.045) in the QFR group. Six times fewer patients required non-culprit artery revascularization within 12-month FU in the QFR group (1.02% vs 6%, p = 0.047). Survival analysis proved that patients in the Angio group had more than 6-time greater risk for death within a 12-month period after MI (OR 6.23,, p = 0.006), with the highest mortality risk within the rst two months after initial treatment. ConclusionsUsing QFR in non-culprit lesions for patients with ST-elevation myocardial infarction reduces mortality rate and revascularization in 12-month follow-up and increases the patient's quality of life. Trial registrationThe study was approved by the Regional Bioethical Committee and conducted under the principles of the Helsinki Declaration and local laws and regulations.

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TCT-106 FFR in Nonculprits in STEMI: A Substudy of the COMPARE-ACUTE Trial

Cited by 6 publications

References 0 publications

FLOWER-MI and the root of the problem with non-culprit revascularisation

FLOWER-MI and the root of the problem with non-culprit revascularisation

Fractional Flow Reserve-Guided Coronary Revascularization: Evidence from Randomized and Non-Randomized Studies

Quantitative flow ratio vs. angiography- only guided PCI in STEMI patients: a one- year outcomes

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