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Clinical outcomes of complete revascularization using either angiography-guided or fractional flow reserve-guided drug-eluting stent implantation in non-culprit vessels in ST elevation myocardial infarction patients: insights from a study based on a systematic review and meta-analysis

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Abstract

Current guidelines recommend that percutaneous coronary intervention (PCI) should be restricted to the culprit vessel in ST elevation myocardial infarction (STEMI) patients with multi-vessel disease (MVD) and without cardiogenic shock. However, newer data suggests that performing complete revascularization (CR) in MVD patients may lead to better outcomes compared to intervention in the culprit vessel only. The aim of this meta-analysis is to examine the available data to determine if CR (using either angio- or fractional flow reserve guidance—FFR) following primary PCI in STEMI patients without cardiogenic shock impacts clinical outcomes. Meta-analysis was performed by conducting a literature search of PubMed from January 2004 to July 2017. Pooled estimates of outcomes, presented as odds ratios (OR) [95% confidence intervals], were generated using random-effect models. A total of 9 studies (3317 patients) were included. CR showed a significant MACE reduction (OR 0.49, 95% CI 0.36–0.66, p < 0.001); All-cause mortality (OR 0.69, 95% CI 0.48–0.98, p = 0.04) and repeat revascularization (OR 0.38, 95% CI 0.28–0.51, p < 0.001) at ≥ 12 months follow-up. The FFR-guiding CR group presented a MACE reduction (odds ratio 0.52, 95% CI 0.30–0.90, p = 0.02) due to a decrease of repeat revascularization (OR 0.41, 95% CI 0.21–0.80, p = 0.009). Overall, performing complete revascularization in STEMI patients showed a MACE reduction, all-cause death and repeat revascularization. Compared to culprit-only revascularization, treating multi-vessel disease in STEMI patients using FFR guidance is associated with decreased incidence of MACE, due to a decreased rate of revascularization.

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  1. Alexandre Hideo-Kajita and Hector M. Garcia-Garcia have contributed equally to this work.

Authors and Affiliations

  1. Division of Interventional Cardiology, MedStar Cardiovascular Research Network, MedStar Washington Hospital Center, 110 Irving Street, East Building, Suite 4B-1, Washington, DC, 20010, USA

    Alexandre Hideo-Kajita, Hector M. Garcia-Garcia, Kayode O. Kuku, Solomon S. Beyene, Viana Azizi, Yael F. Meirovich, Gebremedhin D. Melaku, Aaphtaab Dheendsa, Echo J. Brathwaite, Sameer Desale, Mohammad Soud, Kazuhiro Dan, Yuichi Ozaki, Ron Waksman & Michael Lipinski

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Ron Waksman, MD: Consultant: Abbott Vascular, Amgen, Biosensors International, Biotronik, Boston Scientific, Corindus, Lifetech Medical, Medtronic, Philips Volcano, Pi-Cardia LTD; Advisory Board: Abbott Vascular, Amgen, Boston Scientific, Medtronic, Philips Volcano, Pi-Cardia LTD; Speakers Bureau: AstraZeneca, Chiesi; Grant Support: Abbott Vascular, AstraZeneca, Biosensors International, Biotronik, Boston Scientific, Chiesi, Edwards Lifesciences; Investor: MedAlliance.

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Hideo-Kajita, A., Garcia-Garcia, H.M., Kuku, K.O. et al. Clinical outcomes of complete revascularization using either angiography-guided or fractional flow reserve-guided drug-eluting stent implantation in non-culprit vessels in ST elevation myocardial infarction patients: insights from a study based on a systematic review and meta-analysis. Int J Cardiovasc Imaging 34, 1349–1364 (2018). https://doi.org/10.1007/s10554-018-1362-9

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