Author + information
- Alexandre Hideo-Kajita1,
- Hector Garcia-Garcia2,
- Kayode Kuku3,
- Solomon Beyene4,
- Viana Azizi5,
- Yael Meirovich6,
- Gebremedhin Melaku7,
- Ahn Bui8,
- Aaphtaab Dheendsa4,
- Echo Brathwaite8,
- Sameer Desale8,
- Michael Lipinski1 and
- Ron Waksman1
- 1Medstar Washington Hospital Center, Washington, District of Columbia, United States
- 2Medstar Washington Medical Center, Bethesda, Maryland, United States
- 3Medstar Washington hospital center, Washington, District of Columbia, United States
- 4medstar washington hospital center, Washington, District of Columbia, United States
- 5Medstar Health Research Institute, Hyattsville, Maryland, United States
- 6MCRN, Washington, District of Columbia, United States
- 7Medstar Health Research Institute, Washington, Maryland, United States
- 8medstar washington hospital center, washington, District of Columbia, United States
Angiographic guidance has been used as the standard method to perform percutaneous complete revascularization (e.g. incomplete revascularization vs. complete revascularization) in ST elevation myocardial infarction (STEMI) patients with multivessel disease (MVD). However, recent studies are exploring whether complete revascularization should be guided by fractional flow reserve (FFR). Overall, the results of FAME-2 trial showed a reduction of major adverse cardiovascular events (MACE) due to the decrease of repeat revascularization events. The aim of this meta-analysis is to examine the available data of FFR-guidance in STEMI patients with MVD.
Meta-analysis was performed by conducting a literature search of Pubmed from January 2004 to May 2017. Pooled estimates of outcomes, presented as odds ratios (OR) [95% confidence intervals], were generated with random-effect models. The analysis compared the population of 3 FFR-guided randomized controlled trials (1631 patients).
The FFR guided treated patients had a reduction of 48% of MACE compared to culprit-only revascularization (OR 0.52, 95% CI: 0.30-0.90, p=0.02) (Figure 1); and 59% reduction in repeat revascularization (OR 0.41, 95% CI: 0.21-0.80, p=0.009). There was no effect on all-cause mortality (OR 1.24, 95% CI: 0.65-2.35, p=0.51) or all-MI (OR 1.04, 95% CI: 0.34-3.34, p=0.95).
Compared to culprit-only revascularization, treating multivessel disease in STEMI patients using FFR guidance is associated with decreased incidence of MACE, due to a decreased rate of revascularization.
IMAGING: FFR and Physiologic Lesion Assessment