Author + information
- Khagendra Dahal,
- Magdy Hanna,
- Hussam Watti,
- Augustine Njoku,
- Pavan Katikaneni and
- Kalgi Modi
Randomized controlled trials (RCTs) have compared the strategies of culprit-only revascularization (CoR) versus complete revascularization (CR) in patients with ST-elevation myocardial infarction (STEMI) and multivessel disease (MVD). The role of fractional flow reserve (FFR) guided complete revascularization is not well-established in patients with STEMI with MVD. We performed a meta-analysis of RCTs comparing FFR-guided CR versus CoR in patients with STEMI with MVD.
Electronic search of PubMed, Cochrane Central, and EMBASE databases was performed in addition to manual search of relevant references for the RCTs from inception through October 31, 2017. Major adverse cardiac events (MACE), mortality, non-fatal myocardial infarction (MI), revascularization, major bleeding, and stroke were the major outcomes.
Data from three published RCTs were included in this meta-analysis with a total of 1633 patients (689 patients in FFR-guided CR and 944 in CoR). FFR-guided CR, compared to CoR resulted in a lower risk of MACE [odds ratio (OR): 0.52 (95% confidence interval: 0.31-0.87; P= 0.01], which was driven by reduction in revascularization [0.34 (0.24 - 0.48); P <0.00001]. No difference was observed in the risks of mortality [1.24 (0.65-2.36); P=0.51], non-fatal MI [1.47 (0.47-4.60); P=0.51], major bleeding [0.56 (0.18-1.74); P=0.31], and stroke [1.11 (0.06-19.47); P=0.73] between the two groups.
In patients presenting with STEMI with multivessel disease, FFR-guided complete revascularization was associated with reduced MACE and revascularization and similar outcomes of mortality, non-fatal MI, major bleeding and stroke.