Korean Circulation Journal

The Korean Society of Cardiology (대한심장학회)
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Revascularization Strategies in Patients With ST-Segment Elevation Myocardial Infarction and Multivessel Disease: Is FFR-Guided Strategy Still Valuable?

  • Doosup Shin (Division of Cardiovascular Medicine, Department of Internal Medicine, University of Iowa Carver College of Medicine) ;
  • Tae-Min Rhee (Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital) ;
  • Seung Hun Lee (Division of Cardiology, Department of Internal Medicine, Heart Center, Chonnam National University Hospital) ;
  • Joo Myung Lee (Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine)
  • Received : 2021.12.20
  • Accepted : 2022.03.10
  • Published : 2022.04.01
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Abstract

Several studies have shown the benefit of complete revascularization (CR) over culprit-only percutaneous coronary intervention (PCI) in patients with ST-segment elevated myocardial infarction (STEMI) and multivessel disease (MVD). Nevertheless, optimal strategy to select targets for non-culprit PCI has not been clarified. In this paper, we critically discuss and compare the safety and efficacy of different strategies for CR in patients with STEMI and MVD using a Bayesian network meta-analysis including all previous randomized controlled trials (RCTs). In Bayesian network meta-analysis of 13 RCTs, culprit-only PCI was associated with higher risk of major adverse cardiac events (MACE), compared with angiography-guided or fractional flow reserve (FFR)-guided CR strategies. However, there was no significant difference between angiography-guided and FFR-guided CR strategies in the risk of MACE and its individual components including all-cause death, cardiac death, myocardial infarction (MI), and revascularization. These evidence support that both angiography-guided and FFR-guided complete revascularization strategies would be reasonable treatment option in patients with STEMI and MVD. If the non-culprit lesion is severe on visual assessment, angiography-guided PCI can be considered. If the non-culprit lesion is intermediate in severity or unclear based on visual assessment, FFR-guided strategy can be used as a reliable and objective tool, providing similar benefits with less stents compared with an angiography-guided strategy. Further RCT is needed to evaluate direct comparison between angiography-guided and FFR-guided CR strategies in patients with STEMI and MVD. Ongoing FRAME-AMI trial (NCT02715518) will provide more evidence regarding this issue.

Keywords

Acknowledgement

Dr. Joo Myung Lee received a Research Grant from St. Jude Medical (Abbott Vascular) and Philips Volcano.

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