System Maintenance Notice

Please note that maintenance work is scheduled between 4 AM and 5 AM - CET. During this time, you may experience reduced performance. Thanks for your patience.

Publications

Journal Article Epublish 1 citation

PubMed: 42765399 DOI: 10.4244/EIJ-D-26-00055

Clinical outcomes of FFR-guided revascularisation of non-culprit lesions in NSTE-ACS.

EuroIntervention 22(18):e970-e977

Authors: Luca Paolucci, Bernard De Bruyne, Gilles Rioufol, Joo-Yong Hahn, Shao-Liang Chen, Bon-Kwon Koo, Pim A L Tonino, Marcel van 't Veer, Pascal Motreff, Denis Angoulvant, Joo Myung Lee, Doyeon Hwang, Seokhun Yang, Nico H J Pijls, Emanuele Barbato, Fabio Mangiacapra, On Behalf Of The Prime Collaboration

Affiliations

  • Research Unit of Cardiovascular Science, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Rome, Italy.
  • Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium.
  • Hospices Civils de Lyon, CarMeN, INSERM 1060, Lyon, France.
  • Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
  • Nanjing First Hospital, Nanjing Medical University, Nanjing, China.
  • Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea.
  • Department of Cardiology, Catharina Hospital, Eindhoven, the Netherlands.
  • Cardiology Department, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France.
  • Cardiology Department, Trousseau Hospital, François Rabelais University of Tours, Tours, France.
  • Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Italy.
  • Cardiology Unit, Sant'Andrea University Hospital of Rome, Rome, Italy.
  • Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy.

Abstract

BACKGROUND

The role of fractional flow reserve (FFR)-guided revascularisation in patients with non-ST-segment elevation acute coronary syndromes (NSTE-ACS) is unclear.

AIMS

We sought to compare the outcomes of FFR-guided and angiography-guided revascularisation in patients with NSTE-ACS and chronic coronary syndrome (CCS).

METHODS

Individual patient data from five randomised clinical trials comparing FFR- and angiography-guided percutaneous coronary intervention (PCI) were pooled and stratified according to the coronary syndrome subtype. The primary outcome was major adverse cardiovascular events (MACE) at 1 year.

RESULTS

Overall, 2,493 patients were considered, including 1,316 (52.8%) with CCS and 1,177 (47.2%) with NSTE-ACS. The relationship between an FFR-guided strategy and the risk of MACE at 1 year was similar across the two groups (CCS: hazard ratio [HR] 0.78, 95% confidence interval [CI]: 0.58-1.05; NSTE-ACS: HR 0.86, 95% CI: 0.63-1.18; p-value for interaction [p-int]=0.792). Similar findings were found for all-cause death (p-int=0.459), myocardial infarction (p-int=0.996) and repeat revascularisation (p-int=0.290). These results were confirmed through an extended exploratory analysis at 5 years of follow-up. In patients with NSTE-ACS randomised to FFR-guided revascularisation, the number of deferred lesions was not associated with an increased risk of MACE.

CONCLUSIONS

FFR-guided revascularisation is associated with a similar clinical benefit in NSTE-ACS and CCS settings. An FFR-guided strategy should be considered to safely reduce unnecessary PCI in patients with NSTE-ACS.

MeSH

Angiography, Cardiac Surgical Procedures, Wounds And Injuries