Complete Revascularization Versus Culprit Lesion Only in Patients With ST-Segment Elevation Myocardial Infarction and Multivessel Disease
| Autor: | Erik Jørgensen, Niels Vejlstrup, Kari Saunamäki, Lars Nepper-Christensen, Adam Ali Ghotbi, Kathrine Ekström, Lene Holmvang, Dan Eik Høfsten, Frants Pedersen, Ole De Backer, Kiril Aleksov Ahtarovski, Lars Køber, Peter Clemmensen, Litten Bertelsen, Jacob Lønborg, Steffen Helqvist, Henning Kelbæk, Christoffer Göransson, Mikkel Malby Schoos, Thomas Engstrøm, Kasper Kyhl |
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| Rok vydání: | 2019 |
| Předmět: |
medicine.medical_specialty
Ejection fraction business.industry medicine.medical_treatment Infarction Percutaneous coronary intervention Fractional flow reserve 030204 cardiovascular system & hematology medicine.disease Revascularization 03 medical and health sciences 0302 clinical medicine Interquartile range Internal medicine Conventional PCI Cardiology Medicine cardiovascular diseases 030212 general & internal medicine Myocardial infarction Cardiology and Cardiovascular Medicine business |
| Zdroj: | JACC: Cardiovascular Interventions. 12:721-730 |
| ISSN: | 1936-8798 |
| Popis: | Objectives The aim of this study was to evaluate the effect of fractional flow reserve (FFR)–guided revascularization compared with culprit-only percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI) on infarct size, left ventricular (LV), function, LV remodeling, and the presence of nonculprit infarctions. Background Patients with STEMI with multivessel disease might have improved clinical outcomes after complete revascularization compared with PCI of the infarct-related artery only, but the impact on infarct size, LV function, and remodeling as well as the risk for periprocedural infarction are unknown. Methods In this substudy of the DANAMI-3 (Third Danish Trial in Acute Myocardial Infarction)–PRIMULTI (Primary PCI in Patients With ST-Elevation Myocardial Infarction and Multivessel Disease: Treatment of Culprit Lesion Only or Complete Revascularization) randomized trial, patients with STEMI with multivessel disease were randomized to receive either complete FFR-guided revascularization or PCI of the culprit vessel only. The patients underwent cardiac magnetic resonance imaging during index admission and at 3-month follow-up. Results A total of 280 patients (136 patients with infarct-related and 144 with complete FFR-guided revascularization) were included. There were no differences in final infarct size (median 12% [interquartile range: 5% to 19%] vs. 11% [interquartile range: 4% to 18%]; p = 0.62), myocardial salvage index (median 0.71 [interquartile range: 0.54 to 0.89] vs. 0.66 [interquartile range: 0.55 to 0.87]; p = 0.49), LV ejection fraction (mean 58 ± 9% vs. 59 ± 9%; p = 0.39), and LV end-systolic volume remodeling (mean 7 ± 22 ml vs. 7 ± 19 ml; p = 0.63). New nonculprit infarction occurring after the nonculprit intervention was numerically more frequent among patients treated with complete revascularization (6 [4.5%] vs. 1 [0.8%]; p = 0.12). Conclusions Complete FFR-guided revascularization in patients with STEMI and multivessel disease did not affect final infarct size, LV function, or remodeling compared with culprit-only PCI. |
| Databáze: | OpenAIRE |
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