Comparing FFR-Guided Complete Revascularization and Conservative Management for Non-Culprit Lesions in STEMI Patients With Multivessel Disease: A Systematic Review and Meta-Analysis

IF 2.1 3区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Catheterization and Cardiovascular Interventions Pub Date : 2024-12-24 DOI:10.1002/ccd.31379

Ahmed R. Gonnah, Ahmed K. Awad, Ahmed E. Helmy, Ahmed B. Elsnhory, Omar Shazly, Saad A. Abousalima, Aser Labib, Hussein Saoudy, Ayman K. Awad, David H. Roberts

{"title":"Comparing FFR-Guided Complete Revascularization and Conservative Management for Non-Culprit Lesions in STEMI Patients With Multivessel Disease: A Systematic Review and Meta-Analysis","authors":"Ahmed R. Gonnah, Ahmed K. Awad, Ahmed E. Helmy, Ahmed B. Elsnhory, Omar Shazly, Saad A. Abousalima, Aser Labib, Hussein Saoudy, Ayman K. Awad, David H. Roberts","doi":"10.1002/ccd.31379","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Background</h3>\n \n <p>In patients with ST-segment elevation myocardial infarction (STEMI) and multivessel coronary artery disease, the optimal management strategy for non-culprit lesions is a subject of ongoing debate. There has been an increasing use of physiology-guidance to assess the extent of occlusion in non-culprit lesions, and hence the need for stenting. Fractional flow reserve (FFR) is commonly used as a technique. This analysis compares FFR versus conservative management in the management of non-culprit lesions in STEMI patients with multivessel disease.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>A comprehensive literature search was conducted on databases from inception to May 25, 2024. We conducted a random-effects meta-analysis using RevMan version 5.3.0, employing the Der-Simonian and Laird method to combine the data.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>The analysis of five RCTs including 3759 patients revealed a significantly lower incidence of major adverse cardiovascular events (composite of all-cause mortality, non-fatal myocardial infarction and the need for repeat revascularization [PCI or CABG]) in the FFR group compared to the conservative management group (RR = 0.65, 95% CI: 0.44−0.96, <i>p</i> = 0.03). The revascularization rates were significantly lower in the FFR group (RR = 0.53, 95% CI: 0.43−0.66, <i>p</i> < 0.00001). Additionally, unplanned hospitalization leading to urgent repeat revascularization and any cause hospitalization were significantly lower in the FFR group (RR = 0.72, 95% CI: 0.56−0.94, <i>p</i> = 0.01), and (RR = 0.62, 95% CI: 0.46−0.84, <i>p</i> = 0.002), respectively. The FFR group had a higher risk of definite stent thrombosis (RR = 2.26, 95% CI: 1.10−4.64, <i>p</i> = 0.03). No significant differences were observed between the two groups in mortality, hospitalization for heart failure, or myocardial infarction. Similarly, bleeding rates, cerebrovascular accidents (CVAs), and contrast-induced nephropathy (CIN) were comparable between both groups.</p>\n </section>\n \n <section>\n \n <h3> Conclusion</h3>\n \n <p>Our findings support FFR-guided PCI to manage non-culprit lesions in STEMI patients with multivessel disease as it is potentially safe, with comparable rates of bleeding, CVAs and CIN. It also improves clinical outcomes, as well as reduces revascularization and hospitalization rates. The risk of stent thrombosis remains a concern, and hence the decision making for FFR-guided complete revascularization should take into account the complexity/risk of the procedure, as well as the patients' individual co-morbidities and preferences.</p>\n </section>\n </div>","PeriodicalId":9650,"journal":{"name":"Catheterization and Cardiovascular Interventions","volume":"105 3","pages":"633-642"},"PeriodicalIF":2.1000,"publicationDate":"2024-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Catheterization and Cardiovascular Interventions","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1002/ccd.31379","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}

引用次数: 0

Abstract

Background

In patients with ST-segment elevation myocardial infarction (STEMI) and multivessel coronary artery disease, the optimal management strategy for non-culprit lesions is a subject of ongoing debate. There has been an increasing use of physiology-guidance to assess the extent of occlusion in non-culprit lesions, and hence the need for stenting. Fractional flow reserve (FFR) is commonly used as a technique. This analysis compares FFR versus conservative management in the management of non-culprit lesions in STEMI patients with multivessel disease.

Methods

A comprehensive literature search was conducted on databases from inception to May 25, 2024. We conducted a random-effects meta-analysis using RevMan version 5.3.0, employing the Der-Simonian and Laird method to combine the data.

Results

The analysis of five RCTs including 3759 patients revealed a significantly lower incidence of major adverse cardiovascular events (composite of all-cause mortality, non-fatal myocardial infarction and the need for repeat revascularization [PCI or CABG]) in the FFR group compared to the conservative management group (RR = 0.65, 95% CI: 0.44−0.96, p = 0.03). The revascularization rates were significantly lower in the FFR group (RR = 0.53, 95% CI: 0.43−0.66, p < 0.00001). Additionally, unplanned hospitalization leading to urgent repeat revascularization and any cause hospitalization were significantly lower in the FFR group (RR = 0.72, 95% CI: 0.56−0.94, p = 0.01), and (RR = 0.62, 95% CI: 0.46−0.84, p = 0.002), respectively. The FFR group had a higher risk of definite stent thrombosis (RR = 2.26, 95% CI: 1.10−4.64, p = 0.03). No significant differences were observed between the two groups in mortality, hospitalization for heart failure, or myocardial infarction. Similarly, bleeding rates, cerebrovascular accidents (CVAs), and contrast-induced nephropathy (CIN) were comparable between both groups.

Conclusion

Our findings support FFR-guided PCI to manage non-culprit lesions in STEMI patients with multivessel disease as it is potentially safe, with comparable rates of bleeding, CVAs and CIN. It also improves clinical outcomes, as well as reduces revascularization and hospitalization rates. The risk of stent thrombosis remains a concern, and hence the decision making for FFR-guided complete revascularization should take into account the complexity/risk of the procedure, as well as the patients' individual co-morbidities and preferences.

查看原文

微信好友朋友圈 QQ好友复制链接

本刊更多论文

比较ffr引导下的完全血运重建术和保守治疗STEMI多血管疾病非罪魁祸首病变：系统回顾和荟萃分析

背景：在st段抬高型心肌梗死（STEMI）和多支冠状动脉疾病患者中，非罪魁祸首病变的最佳治疗策略是一个持续争论的主题。越来越多的人使用生理学指导来评估非罪魁祸首病变的闭塞程度，因此需要支架植入术。部分流量储备（FFR）是一种常用的技术。该分析比较了FFR与保守治疗在STEMI合并多血管疾病的非罪魁祸首病变治疗中的作用。方法：对数据库进行全面的文献检索，检索时间为建库至2024年5月25日。我们使用RevMan 5.3.0版本进行随机效应meta分析，采用Der-Simonian和Laird方法对数据进行合并。结果：5项随机对照试验（RCTs）共3759例患者的分析显示，与保守治疗组相比，FFR组的主要不良心血管事件（全因死亡率、非致死性心肌梗死和需要重复血运重建术[PCI或CABG]）的发生率显著降低（RR = 0.65, 95% CI: 0.44-0.96, p = 0.03）。结论：我们的研究结果支持FFR引导下的PCI治疗STEMI多血管疾病患者的非罪魁祸首病变，因为它具有潜在的安全性，出血、CVAs和CIN的发生率相当。它还能改善临床结果，降低血运重建术和住院率。支架血栓形成的风险仍然是一个值得关注的问题，因此，ffr引导下的完全血运重建术的决策应考虑手术的复杂性/风险，以及患者的个人合并症和偏好。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文去求助

来源期刊

Catheterization and Cardiovascular Interventions 医学-心血管系统

CiteScore

5.40

自引率

8.70%

发文量

419

审稿时长

2 months

期刊介绍： Catheterization and Cardiovascular Interventions is an international journal covering the broad field of cardiovascular diseases. Subject material includes basic and clinical information that is derived from or related to invasive and interventional coronary or peripheral vascular techniques. The journal focuses on material that will be of immediate practical value to physicians providing patient care in the clinical laboratory setting. To accomplish this, the journal publishes Preliminary Reports and Work In Progress articles that complement the traditional Original Studies, Case Reports, and Comprehensive Reviews. Perspective and insight concerning controversial subjects and evolving technologies are provided regularly through Editorial Commentaries furnished by members of the Editorial Board and other experts. Articles are subject to double-blind peer review and complete editorial evaluation prior to any decision regarding acceptability.