Angiographic Severity of the Nonculprit Lesion and the Efficacy of Fractional Flow Reserve-Guided Complete Revascularization in Patients With AMI: FRAME-AMI Substudyopen access
- Authors
- Seung, Jaeho; Choo, Eun Ho; Kim, Chan Joon; Kim, Hyun Kuk; Park, Keun Ho; Lee, Seung Hun; Kim, Min Chul; Hong, Young Joon; Ahn, Sung Gyun; Doh, Joon-Hyung; Lee, Sang Yeub; Park, Sang Don; Lee, Hyun-Jong; Kang, Min Gyu; Koh, Jin-Sin; Cho, Yun-Kyeong; Nam, Chang-Wook; Koo, Bon-Kwon; Lee, Bong-Ki; Yun, Kyeong Ho; Hong, David; Joh, Hyun Sung; Choi, Ki Hong; Park, Taek Kyu; Lee, Joo Myung; Yang, Jeong Hoon; Song, Young Bin; Choi, Seung-Hyuk; Gwon, Hyeon-Cheol; Hahn, Joo-Yong
- Issue Date
- Jan-2024
- Publisher
- Lippincott Williams and Wilkins
- Keywords
- coronary angiography; drug-eluting stents; myocardial infarction; percutaneous coronary intervention; prognosis
- Citation
- Circulation: Cardiovascular Interventions, v.17, no.1, pp E013611
- Indexed
- SCIE
SCOPUS
- Journal Title
- Circulation: Cardiovascular Interventions
- Volume
- 17
- Number
- 1
- Start Page
- E013611
- URI
- https://scholarworks.gnu.ac.kr/handle/sw.gnu/69487
- DOI
- 10.1161/CIRCINTERVENTIONS.123.013611
- ISSN
- 1941-7640
1941-7632
- 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. © 2023 American Heart Association, Inc.
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