Author + information
- Received October 9, 2019
- Revision received February 4, 2020
- Accepted February 11, 2020
- Published online April 20, 2020.
- Zsolt Piróth, MD, PhDa,
- Bianca M. Boxma-de Klerk, PhDb,c,
- Elmir Omerovic, MDd,
- Péter Andréka, MD, PhDa,
- Géza Fontos, MDa,
- Gábor Fülöp, MDa,
- Mohamed Abdel-Wahab, MDe,
- Franz-Josef Neumann, MDf,
- Gert Richardt, MD, PhDg,
- Mohammad Abdelghani, MDg and
- Pieter C. Smits, MD, PhDb,∗ ()
- aHungarian Institute of Cardiology, Budapest, Hungary
- bDepartment of Cardiology, Maasstad Ziekenhuis, Rotterdam, the Netherlands
- cFranciscus Gasthuis & Vlietland, Department of Statistics and Education, Franciscus Academy, Rotterdam, the Netherlands
- dDepartment of Cardiology, Gothenburg University Hospital, Gothenburg, Sweden
- eDepartment of Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
- fDepartment of Cardiology, University Heart Center Freiburg–Bad Krozingen, Bad Krozingen, Germany
- gDepartment of Cardiology, Heart Center, Segeberger Kliniken, Bad Segeberg, Germany
- ↵∗Address for correspondence:
Dr. Pieter C. Smits, Maasstad Hospital, Department of Cardiology, Maasstadweg 21, 3079 DZ Rotterdam, the Netherlands.
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.
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received October 9, 2019.
- Revision received February 4, 2020.
- Accepted February 11, 2020.
- 2020 American College of Cardiology Foundation
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