The Natural History of Nonculprit Lesions in STEMI: An FFR Substudy of the Compare-Acute Trial

Zsolt Piróth; Bianca M Boxma-de Klerk; Elmir Omerovic; Péter Andréka; Géza Fontos; Gábor Fülöp; Mohamed Abdel-Wahab; Franz-Josef Neumann; Gert Richardt; Mohammad Abdelghani; Pieter C Smits

doi:10.1016/j.jcin.2020.02.015

The Natural History of Nonculprit Lesions in STEMI: An FFR Substudy of the Compare-Acute Trial

JACC Cardiovasc Interv. 2020 Apr 27;13(8):954-961. doi: 10.1016/j.jcin.2020.02.015.

Affiliations

¹ Hungarian Institute of Cardiology, Budapest, Hungary.
² Department of Cardiology, Maasstad Ziekenhuis, Rotterdam, the Netherlands; Franciscus Gasthuis & Vlietland, Department of Statistics and Education, Franciscus Academy, Rotterdam, the Netherlands.
³ Department of Cardiology, Gothenburg University Hospital, Gothenburg, Sweden.
⁴ Department of Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany.
⁵ Department of Cardiology, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany.
⁶ Department of Cardiology, Heart Center, Segeberger Kliniken, Bad Segeberg, Germany.
⁷ Department of Cardiology, Maasstad Ziekenhuis, Rotterdam, the Netherlands. Electronic address: [email protected].

PMID: 32327091
DOI: 10.1016/j.jcin.2020.02.015

Abstract

Objectives: The aim of this study was to determine the prognostic value of fractional flow reserve (FFR) in non-infarct-related arteries (IRAs) in ST-segment elevation myocardial infarction (MI).

Background: Patients with ST-segment elevation MI often present with multivessel disease. The treatment of non-IRAs is debated. The applicability of FFR has not been widely proved.

Methods: Outcomes were analyzed in all patients in the Compare-Acute (Comparison Between FFR Guided Revascularization Versus Conventional Strategy in Acute STEMI Patients With MVD) trial in whom, after successful primary percutaneous coronary intervention, non-IRAs were interrogated using FFR and treated medically. The treating cardiologist was blinded to the FFR value. The primary endpoint was the composite of cardiovascular mortality, target vessel-related (non-IRA with FFR measurement at primary percutaneous coronary intervention) nonfatal MI, and target vessel revascularization: major adverse cardiac events (MACE) at 24 months.

Results: A total of 751 patients (963 vessels) were included. Target non-IRAs with MACE had lower FFR compared with those without (0.78 vs. 0.84, respectively; p < 0.001). The median FFR of non-IRAs with TVR was lower than that of those without (0.79 vs. 0.85, respectively; p < 0.001). The difference was significant in all vessels. The median FFR of target non-IRAs with MI was lower than that of those without (0.79 vs. 0.84, respectively; p = 0.016). The MACE rate was significantly (p < 0.001) higher in the lowest of FFR tertiles (<0.80) compared with the others (0.80 to 0.87 and ≥0.88).

Conclusions: In patients with ST-segment elevation MI with multivessel disease, FFR measured in the medically treated non-IRA immediately after successful primary percutaneous coronary intervention shows a nonlinear and inverse risk continuum of MACE. Importantly, worsening prognosis is demonstrated around the cutoff of 0.80.

Keywords: FFR; STEMI; nonculprit lesions.

Publication types

Randomized Controlled Trial

MeSH terms

Aged
Cardiac Catheterization*
Coronary Artery Disease / diagnosis*
Coronary Artery Disease / mortality
Coronary Artery Disease / physiopathology
Coronary Artery Disease / therapy*
Coronary Vessels / physiopathology*
Female
Fractional Flow Reserve, Myocardial*
Humans
Male
Middle Aged
Percutaneous Coronary Intervention* / adverse effects
Percutaneous Coronary Intervention* / mortality
Predictive Value of Tests
Prospective Studies
Risk Assessment
Risk Factors
ST Elevation Myocardial Infarction / diagnosis*
ST Elevation Myocardial Infarction / mortality
ST Elevation Myocardial Infarction / physiopathology
ST Elevation Myocardial Infarction / therapy*
Time Factors
Treatment Outcome