Ezenna Chidubem, Krishna Mrinal Murali, Joseph Meghna, Pereira Vinicius, Ramesh Prasana, Ismayl Mahmoud, Nanna Michael G, Goldsweig Andrew M
Department of Medicine, University of Massachusetts - Baystate Medical Center, Springfield, MA, USA. Electronic address: https://twitter.com/CEzenna_MD.
Department of Medicine, Medical College Thiruvananthapuram, India. Electronic address: https://twitter.com/MrinalMkrishna.
Cardiovasc Revasc Med. 2024 Dec 19. doi: 10.1016/j.carrev.2024.12.004.
The optimal revascularization strategy for patients with myocardial infarction (MI) and multivessel coronary artery disease (CAD) remains an area of research and debate. Fractional flow reserve (FFR)-guided complete revascularization (CR) by percutaneous coronary intervention (PCI) has emerged as an alternative to traditional culprit-only PCI.
To investigate the outcomes of FFR-guided CR versus culprit-only PCI in patients with MI and multivessel CAD.
We systematically searched PubMed, Scopus and Cochrane Central databases for randomized controlled trials (RCTs) comparing FFR-guided CR versus culprit-only PCI in MI patients with multivessel CAD. Outcomes included a composite of all-cause death, MI, stroke and repeat revascularization, these individual outcomes, cardiac death, stent thrombosis (definite or probable), and contrast-induced acute kidney injury (CIAKI). Random effects models were used to generate risk ratios (RRs) with 95 % confidence intervals (CIs).
The search identified 5 RCTs including 4618 patients with a median follow-up duration of 3 years. Compared with culprit-only PCI, FFR-guided CR was associated with less composite adverse events (RR 0.73; 95%CI 0.57-0.92; p = 0.009), cardiac death (RR 0.73; 95%CI 0.55-0.97; p = 0.03), and repeat revascularization (RR 0.61; 95%CI 0.44-0.84; p = 0.003). Both strategies were similar in terms of all-cause death, MI, stroke, stent thrombosis, and CIAKI.
FFR-guided complete revascularization appears to be superior to culprit-only PCI in reducing composite adverse events, cardiac death, and the need for repeat revascularization in patients with MI and multivessel CAD without a significant impact on recurrent myocardial infarction rates.
4618-patient meta-analysis: in MI w/ multivessel #CAD, #FFR-guided complete revascularization yields less composite adverse events, cardiac death & repeat revascularization than culprit-only #PCI.
心肌梗死（MI）合并多支冠状动脉疾病（CAD）患者的最佳血运重建策略仍是一个研究和争论的领域。经皮冠状动脉介入治疗（PCI）中，基于血流储备分数（FFR）指导的完全血运重建（CR）已成为传统仅处理罪犯病变PCI的替代方案。
探讨在心肌梗死合并多支冠状动脉疾病患者中，基于FFR指导的完全血运重建与仅处理罪犯病变PCI的疗效。
我们系统检索了PubMed、Scopus和Cochrane Central数据库，以查找比较心肌梗死合并多支冠状动脉疾病患者中基于FFR指导的完全血运重建与仅处理罪犯病变PCI的随机对照试验（RCT）。结局指标包括全因死亡、心肌梗死、卒中及再次血运重建的复合结局，这些单项结局指标、心源性死亡、支架血栓形成（确诊或疑似）以及造影剂诱导的急性肾损伤（CIAKI）。采用随机效应模型生成风险比（RRs）及95%置信区间（CIs）。
检索到5项随机对照试验，共纳入4618例患者，中位随访时间为3年。与仅处理罪犯病变PCI相比，基于FFR指导的完全血运重建与较少的复合不良事件（RR 0.73；95%CI 0.57 - 0.92；p = 0.009）、心源性死亡（RR 0.73；95%CI 0.55 - 0.97；p = 0.03）及再次血运重建（RR 0.61；95%CI 0.44 - 0.84；p = 0.003）相关。两种策略在全因死亡、心肌梗死、卒中、支架血栓形成及造影剂诱导的急性肾损伤方面相似。
在心肌梗死合并多支冠状动脉疾病患者中，基于FFR指导的完全血运重建在减少复合不良事件、心源性死亡及再次血运重建需求方面似乎优于仅处理罪犯病变PCI，且对复发性心肌梗死发生率无显著影响。
4618例患者的荟萃分析：在心肌梗死合并多支冠状动脉疾病中，基于FFR指导的完全血运重建比仅处理罪犯病变PCI产生更少的复合不良事件、心源性死亡及再次血运重建。
