Dataset Information

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.

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.

SUBMITTER: Gupta A

PROVIDER: S-EPMC5758864 | biostudies-literature | 2018 Feb

REPOSITORIES: biostudies-literature

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Publications

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.

Gupta Ankur A Bajaj Navkaranbir S NS Arora Pankaj P Arora Garima G Qamar Arman A Bhatt Deepak L DL

International journal of cardiology 20180201

<h4>Background</h4>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.<h4>Met ...[more]

PMID: 29249439

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Project description:Background Data are limited regarding long-term outcomes in patients with ST-segment-elevation myocardial infarction and multivessel disease presenting with cardiogenic shock according to revascularization strategy. We sought to compare the 3-year clinical outcomes of patients with ST-segment-elevation myocardial infarction multivessel disease with cardiogenic shock and patients with multivessel percutaneous coronary intervention (PCI) and infarct-related artery (IRA)-only PCI. Methods and Results Of 13 104 patients from the nationwide, multicenter, prospective KAMIR-NIH (Korea Acute Myocardial Infarction Registry--National Institutes of Health) registry, we selected 659 patients with ST-segment-elevation myocardial infarction who had concomitant non-IRA stenosis and presented with cardiogenic shock. The primary outcome was all-cause death. Multivessel PCI was performed in 260 patients and IRA-only PCI in 399 patients. At 3 years, patients in the multivessel PCI group had a lower risk of all-cause death (adjusted hazard ratio, 0.65; 95% CI, 0.45-0.94 [P=0.024]), all-cause death or MI (adjusted hazard ratio, 0.59; 95% CI, 0.41-0.84 [P=0.004]), and non-IRA repeat revascularization (adjusted hazard ratio, 0.23; 95% CI, 0.10-0.50 [P<0.001]) than those in the IRA-only PCI group. The results were consistent after confounder adjustment by propensity score matching and inverse probability weighting analysis. Landmark analysis at 1 year demonstrated that the multivessel PCI group had a lower risk of recurrent MI and non-IRA repeat revascularization beyond 1 year (log-rank P=0.030 and P=0.017, respectively) than the IRA-only PCI group. Conclusions In patients with ST-segment-elevation myocardial infarction and cardiogenic shock, multivessel PCI was associated with a lower risk of all-cause death than IRA-only PCI at 3 years, suggesting potential benefit of non-IRA revascularization during the index hospitalization to improve long-term clinical outcomes.

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Dataset Information

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.

Background

Methods

Results

Conclusions

Publications

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.

Similar Datasets

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