Department of Cardiology, Rigshospitalet, Copenhagen, Denmark.
Department of Cardiology, Rigshospitalet, Copenhagen, Denmark.
JACC Cardiovasc Interv. 2019 Apr 22;12(8):721-730. doi: 10.1016/j.jcin.2019.01.248.
The aim of this study was to evaluate the effect of fractional flow reserve (FFR)-guided revascularization compared with culprit-only percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI) on infarct size, left ventricular (LV), function, LV remodeling, and the presence of nonculprit infarctions.
Patients with STEMI with multivessel disease might have improved clinical outcomes after complete revascularization compared with PCI of the infarct-related artery only, but the impact on infarct size, LV function, and remodeling as well as the risk for periprocedural infarction are unknown.
In this substudy of the DANAMI-3 (Third Danish Trial in Acute Myocardial Infarction)-PRIMULTI (Primary PCI in Patients With ST-Elevation Myocardial Infarction and Multivessel Disease: Treatment of Culprit Lesion Only or Complete Revascularization) randomized trial, patients with STEMI with multivessel disease were randomized to receive either complete FFR-guided revascularization or PCI of the culprit vessel only. The patients underwent cardiac magnetic resonance imaging during index admission and at 3-month follow-up.
A total of 280 patients (136 patients with infarct-related and 144 with complete FFR-guided revascularization) were included. There were no differences in final infarct size (median 12% [interquartile range: 5% to 19%] vs. 11% [interquartile range: 4% to 18%]; p = 0.62), myocardial salvage index (median 0.71 [interquartile range: 0.54 to 0.89] vs. 0.66 [interquartile range: 0.55 to 0.87]; p = 0.49), LV ejection fraction (mean 58 ± 9% vs. 59 ± 9%; p = 0.39), and LV end-systolic volume remodeling (mean 7 ± 22 ml vs. 7 ± 19 ml; p = 0.63). New nonculprit infarction occurring after the nonculprit intervention was numerically more frequent among patients treated with complete revascularization (6 [4.5%] vs. 1 [0.8%]; p = 0.12).
Complete FFR-guided revascularization in patients with STEMI and multivessel disease did not affect final infarct size, LV function, or remodeling compared with culprit-only PCI.
本研究旨在评估与仅罪犯血管经皮冠状动脉介入治疗（PCI）相比，在 ST 段抬高型心肌梗死（STEMI）患者中，基于血流储备分数（FFR）的血运重建对梗死面积、左心室（LV）功能、LV 重构以及非罪犯梗死的影响。
与仅行梗死相关动脉 PCI 相比，多支血管病变的 STEMI 患者行完全血运重建可能会获得更好的临床结果，但对梗死面积、LV 功能和重构的影响以及围手术期梗死的风险尚不清楚。
本研究为 DANAMI-3（急性心肌梗死第三次丹麦试验）-PRIMULTI（STEMI 合并多支血管病变患者的直接 PCI：仅罪犯病变治疗或完全血运重建）随机试验的亚组研究，多支血管病变的 STEMI 患者被随机分为接受完全 FFR 指导的血运重建或仅罪犯血管 PCI。患者在入院时和 3 个月随访时接受心脏磁共振成像检查。
共纳入 280 例患者（136 例为梗死相关血管，144 例为完全 FFR 指导的血运重建）。最终梗死面积无差异（中位数 12%[四分位距：5%19%]与 11%[四分位距：4%18%]；p=0.62）、心肌挽救指数（中位数 0.71[四分位距：0.540.89]与 0.66[四分位距：0.550.87]；p=0.49）、LV 射血分数（均值 58±9%与 59±9%；p=0.39）和 LV 收缩末期容积重构（均值 7±22 ml 与 7±19 ml；p=0.63）。完全血运重建组术后非罪犯血管介入治疗后新发非罪犯梗死的发生率略高（6[4.5%]例与 1[0.8%]例；p=0.12）。
与仅罪犯 PCI 相比，STEMI 合并多支血管病变患者接受完全 FFR 指导的血运重建并未影响最终梗死面积、LV 功能或重构。
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