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

Jaeho Seung, Eun Ho Choo, Chan Joon Kim, Hyun Kuk Kim, Keun Ho Park, Seung Hun Lee, Min Chul Kim, Young Joon Hong, Sung Gyun Ahn, Joon Hyung Doh, Sang Yeub Lee, Sang Don Park, Hyun Jong Lee, Min Gyu Kang, Jin Sin Koh, Yun Kyeong Cho, Chang Wook Nam, Bon Kwon Koo, Bong Ki Lee, Kyeong Ho YunDavid Hong, Hyun Sung Joh, Ki Hong Choi, Taek Kyu Park, Joo Myung Lee, Jeong Hoon Yang, Young Bin Song, Seung Hyuk Choi, Hyeon Cheol Gwon, Joo Yong Hahn

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

BACKGROUND: The benefit of fractional flow reserve-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.

Original languageEnglish
Pages (from-to)E013611
JournalCirculation: Cardiovascular Interventions
Volume17
Issue number1
DOIs
StatePublished - 1 Jan 2024

Bibliographical note

Publisher Copyright:
© 2023 American Heart Association, Inc.

Keywords

  • coronary angiography
  • drug-eluting stents
  • myocardial infarction
  • percutaneous coronary intervention
  • prognosis

Fingerprint

Dive into the research topics of 'Angiographic Severity of the Nonculprit Lesion and the Efficacy of Fractional Flow Reserve-Guided Complete Revascularization in Patients With AMI: FRAME-AMI Substudy'. Together they form a unique fingerprint.

Cite this