Angiographic Severity of the Nonculprit Lesion and the Efficacy of Fractional Flow Reserve–Guided Complete Revascularization in Patients With AMI: FRAME-AMI Substudy-Reference-Cited by-同舟云学术

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

Published:2024-01 Issue:1 Volume:17 Page:
ISSN:1941-7640
Container-title:Circulation: Cardiovascular Interventions
language:en
Short-container-title:Circ: Cardiovascular Interventions

Author:

Seung Jaeho¹^ORCID,Choo Eun Ho¹^ORCID,Kim Chan Joon²,Kim Hyun Kuk³^ORCID,Park Keun Ho³,Lee Seung Hun⁴^ORCID,Kim Min Chul⁴^ORCID,Hong Young Joon⁴^ORCID,Ahn Sung Gyun⁵^ORCID,Doh Joon-Hyung⁶^ORCID,Lee Sang Yeub⁷⁸^ORCID,Park Sang Don⁹,Lee Hyun-Jong¹⁰,Kang Min Gyu¹¹^ORCID,Koh Jin-Sin¹¹^ORCID,Cho Yun-Kyeong¹²^ORCID,Nam Chang-Wook¹²^ORCID,Koo Bon-Kwon¹³,Lee Bong-Ki¹⁴^ORCID,Yun Kyeong Ho¹⁵^ORCID,Hong David¹⁶^ORCID,Joh Hyun Sung¹⁶^ORCID,Choi Ki Hong¹⁶^ORCID,Park Taek Kyu¹⁶^ORCID,Lee Joo Myung¹⁶,Yang Jeong Hoon¹⁶^ORCID,Song Young Bin¹⁶^ORCID,Choi Seung-Hyuk¹⁶^ORCID,Gwon Hyeon-Cheol¹⁶^ORCID,Hahn Joo-Yong¹⁶^ORCID,

Affiliation:

1. Seoul St. Mary’s Hospital (J.S., E.H.C.), The Catholic University of Korea, Seoul.

2. Uijeongbu St. Mary’s Hospital (C.J.K.), The Catholic University of Korea, Seoul.

3. Chosun University Hospital, University of Chosun College of Medicine, Gwangju, Korea (H.K.K., K.H.P.).

4. Chonnam National University Hospital, Gwangju, Korea (S.H.L., M.C.K., Y.J.H.).

5. Wonju College of Medicine, Wonju Severance Christian Hospital, Yonsei University, Korea (S.G.A.).

6. Department of Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea (J.-H.D.).

7. Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea (S.Y.L.).

8. Division of Cardiology, Department of Internal Medicine, Chung-Ang University College of Medicine, Chung-Ang University Gwangmyeong Hospital, Korea (S.Y.L.).

9. Inha University Hospital, Incheon (S.D.P.).

10. Sejong General Hospital, Bucheon, Korea (H.-J.L.).

11. Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, Jinju, Korea (M.G.K., J.-S.H.).

12. Dongsan Medical Center, Keimyung University, Daegu, Korea (Y.-K.C., C.-W.N.).

13. Seoul National University Hospital, Korea (B.-K.K.).

14. Kangwon National University School of Medicine, Chuncheon, Korea (B.-K.L.).

15. Wonkwang University Hospital, Iksan, Korea (K.H.Y.).

16. Samsung Medical Center, Heart Vascular Stroke Institute, Sungkyunkwan University School of Medicine, Seoul, Korea (D.H., H.S.J., K.H.C., T.K.P., J.M.L., J.H.Y., Y.B.S., S.-H.C., H.-C.G., J.-Y.H.).

Abstract

BACKGROUND: The benefit of fractional flow reserve (FFR)–guided percutaneous coronary intervention (PCI) for noninfarct-related artery (IRA) lesions with angiographically severe stenosis in patients with acute myocardial infarction is unclear. METHODS: Among 562 patients from the FRAME-AMI trial (Fractional Flow Reserve Versus Angiography-Guided Strategy for Management of Non-Infraction Related Artery Stenosis in Patients With Acute Myocardial Infarction) 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 end point (death, myocardial infarction, 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 end point occurred in 14 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% CI, 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% versus 15.1%; P =0.008) and those with QCA stenosis <70% (1.0% versus 9.6%; P =0.042) compared with angiography-guided PCI. CONCLUSIONS: In patients with acute myocardial infarction and multivessel disease, FFR-guided PCI tended to have a lower risk of primary end point than angiography-guided PCI regardless of non-IRA stenosis severity without significant interaction. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT02715518.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Cardiology and Cardiovascular Medicine

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