FFR-guided multivessel stenting reduces urgent revascularization compared with infarct-related artery only stenting in ST-elevation myocardial infarction: A meta-analysis of randomized controlled trials

Int J Cardiol. 2018 Feb 1;252:63-67. doi: 10.1016/j.ijcard.2017.07.041.

Abstract

Background: Randomized controlled trials (RCTs) have shown fractional flow reserve-guided (FFR) multivessel stenting to be superior to infarct-related artery (IRA) only stenting in patients with ST-elevation myocardial infarction (STEMI) and multivessel disease. This effect was mainly driven by a reduction in overall repeat revascularization. However, the ability to assess the effect of this strategy on urgent revascularization or reinfarction was underpowered in individual trials.

Methods: We searched Pubmed, EMBASE, Cochrane CENTRAL, and Web of Science for RCTs of FFR-guided multivessel stenting versus IRA-only stenting in STEMI with multivessel disease. The outcomes of interest were death, reinfarction, urgent, and non-urgent repeat revascularization. Risk ratios (RR) were pooled using the DerSimonian and Laird random-effects model.

Results: After review of 786 citations, 2 RCTs were included. The pooled results demonstrated a significant reduction in the composite of death, reinfarction, or revascularization in the FFR-guided multivessel stenting group versus IRA-only stenting group (RR [95%, Confidence Interval]: 0.49 [0.33-0.72], p<0.001). This risk reduction was driven mainly by a reduction in repeat revascularization, both urgent (0.41 [0.24-0.71], p=0.002) and non-urgent revascularization (0.31 [0.19-0.50], p<0.001). Pooled RR for reinfarction was lower in the FFR-guided strategy, but was not statistically significant (0.71[0.39-1.31], p=0.28).

Conclusions: This systematic review and meta-analysis suggests that a strategy of FFR-guided multivessel stenting in STEMI patients reduces not only overall repeat revascularization but also urgent revascularization. The effect on reinfarction needs to be evaluated in larger trials.

Keywords: FFR; Meta-analysis; Multivessel; PCI; STEMI; Stenting.

Publication types

  • Comparative Study
  • Meta-Analysis
  • Systematic Review

MeSH terms

  • Blood Flow Velocity / physiology*
  • Humans
  • Multicenter Studies as Topic / methods
  • Myocardial Infarction / diagnosis
  • Myocardial Infarction / physiopathology
  • Myocardial Infarction / surgery
  • Myocardial Revascularization / methods*
  • Percutaneous Coronary Intervention / methods*
  • Randomized Controlled Trials as Topic / methods*
  • ST Elevation Myocardial Infarction / diagnosis
  • ST Elevation Myocardial Infarction / physiopathology
  • ST Elevation Myocardial Infarction / surgery*
  • Stents*