Home News FFR-guided PCI for nonculprit lesions improves outcomes in acute MI, multivessel disease

FFR-guided PCI for nonculprit lesions improves outcomes in acute MI, multivessel disease

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August 28, 2022

2 min read

Source/Disclosures

Source:

Hahn JY, et al. Hot Line 7. Presented at: European Society of Cardiology Congress; Aug. 26-29, 2022; Barcelona, Spain (hybrid meeting).

Disclosures:
The study was investigator-initiated and was funded by grant support from Biotronik, Chong Kun Dang Pharmaceutical, JW Pharmaceutical and Medtronic.


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In patients with acute MI and multivessel CAD, a fractional flow reserve-guided PCI strategy for non-infarct-related artery lesions was superior to an angiography-guided PCI strategy, according to the results of the FRAME-AMI trial.

“Among patients with acute myocardial infarction and multivessel coronary artery disease, a strategy of selective PCI of non-infarct-related artery lesions using FFR-guided decision making was superior to a strategy of routine PCI based on angiographic diameter stenosis in non-IRA regarding a composite of death, MI, or repeat revascularization,” Joo-Yong Hahn, MD, PhD, professor of medicine at Samsung Medical Center, Seoul, South Korea, said during a press conference at the European Society of Cardiology Congress. “In other words, FFR beats angiography for nonculprit lesions in patients with AMI and multivessel disease.”

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Hahn and colleagues conducted the investigator-initiated, randomized FRAME-AMI trial of 562 patients with acute MI and multivessel disease to compare FFR-guided PCI with angiography-guided PCI in non-infarct-related artery lesions that were amenable to PCI.

In the FFR group, non-infarct-related artery lesions with FFR 0.8 or lower were treated with PCI, while in the angiography group, non-infarct-related artery lesions with diameter stenosis > 50% on visual estimation were treated with PCI, Hahn said at the press conference.

At 3.5 years, the primary endpoint of all-cause death, MI or unplanned revascularization occurred in 7.4% of the FFR group and 19.7% of the angiography group (HR = 0.43; 95% CI, 0.25-0.75; P = .003), according to the researchers.

The rates of all-cause death (2.1% vs. 8.5%), cardiac death (1.4% vs. 8.2%) and MI (2.5% vs. 8.9%) were significantly lower in the FFR group than in the angiography group, Hahn said at the press conference.

“The incidence of [unplanned] revascularization was numerically lower in the FFR-guided PCI group compared with the angiography-guided PCI group, but statistical significance was not achieved,” Hahn said.

The results “shed light on the efficacy and safety of doing selective PCI of non-infarct-related artery lesions using FFR-guided decision making in patients with AMI and multivessel disease,” he said. “For treatment of non-infarct-related artery lesions, FFR-guided PCI reduced the risk of death, MI, or repeat revascularization with fewer number of stents and less contrast media compared with angiography-guided PCI.”

Hahn said approximately 60% of patients had their nonculprit lesions assessed and treated immediately and the rest had assessment and treatment performed later during the same hospital stay. He also said enrollment was stopped early due to recruitment difficulties during the COVID-19 pandemic.

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