Abstract 4139844: Clinical Relevance of FFR-guided PCI According to Left Ventricular Systolic Function in Patients with Acute Myocardial Infarction and Multivessel Disease

Background: Fractional flow reserve (FFR) or angiography-guided complete revascularization was not evaluated in patients with acute myocardial infarction (MI) with reduced left ventricular ejection fraction (LVEF). Objectives: To evaluate impact of FFR-guided percutaneous coronary intervention (PCI) for AMI patients with multivessel disease according to left ventricular systolic function. Methods: We performed pre-specified analysis of FRAME-AMI trial which randomly allocated 562 patients into either FFR-guided PCI (FFR≤0.80) or angiography-guided PCI (diameter stenosis of >50%) for non-infarct related artery (IRA). Patients were classified by LVEF into the preserved (LVEF ≥50%) and reduced (LVEF <50%) groups. The primary end point was patient-oriented composite outcome (POCO), a composite of death, MI, and repeat revascularization. Results: Overall, 187 patients (33.3%) had reduced LVEF. At 4-year follow-up, AMI patients with reduced LVEF showed increased risk of MACE than those with preserved LVEF (18.9% vs. 10.8%; adjusted HR=2.65, 95% CI 1.53-4.58, P<0.001). FFR-guided PCI for non-IRA significantly reduced POCO among preserved LVEF group (3.3% vs. 19.0%; adjusted HR=0.23, 95% CI 0.09-0.59, P=0.002). Conversely, there was no significant difference in POCO between FFR and angiography-guided PCI among reduced LVEF group (17.0% vs. 21.0%; HR=0.64, 95% CI 0.31-1.32, P=0.227). The prognostic impact of FFR-guided PCI tended to increase as LVEF increased (adjusted HR for POCO: 0.69 vs. 0.66 vs. 0.25 vs. 0.20, respectively, for the LVEF ≤40% vs. 40-50% vs. 50-60% vs. ≥60%, interaction P=0.028). Conclusion: In acute MI patients with multivessel disease, FFR-guided PCI for non-IRA showed differential clinical impact according to left ventricular systolic function. The beneficial effect of FFR-guided PCI might be maximized among patients with preserved LVEF rather than reduced LVEF.

Authors

Institutions

Publication Details

Journal
Circulation
Published
2024-11-12
DOI
https://doi.org/10.1161/circ.150.suppl_1.4139844
Primary Topic
Cardiac Imaging and Diagnostics
Type
article
Field-Weighted Citation Impact
0.00
Controls
|||
ALL TIME
JAN
FEB
MAR
APR
MAY
JUN
JUL
AUG
SEP
OCT
article

Abstract 4139844: Clinical Relevance of FFR-guided PCI According to Left Ventricular Systolic Function in Patients with Acute Myocardial Infarction and Multivessel Disease

Joo Myung Lee, Yong-Kyu Lee, Ki Hong Choi, Seung‐Hyuk Choi et al.
Circulation
Cardiac Imaging and Diagnostics
article

Abstract 4139844: Clinical Relevance of FFR-guided PCI According to Left Ventricular Systolic Function in Patients with Acute Myocardial Infarction and Multivessel Disease

Joo Myung Lee, Yong-Kyu Lee, Ki Hong Choi, Seung‐Hyuk Choi, Hyeon‐Cheol Gwon, Eun Ho Choo, G.-T. Ahn, Joon‐Hyung Doh, Sang Yeub Lee, Jeong Hoon Yang, Jin‐Sin Koh, Hyun Kuk Kim, David Hong, Doo Sun Sim, Young Bin Song, Ju Han Kim, Chan Joon Kim, Taek Kyu Park, Kyung-Hoon Cho, Joon Ho Ahn, Min Gyu Kang, Hangyul Kim, Youngkeun Ahn, Joo‐Yong Hahn, Chang‐Wook Nam, Keun Ho Park, Seung Hun Lee, Min Chul Kim, Hyun‐Jong Lee, Sang‐Don Park, Young Joon Hong, Myung Ho Jeong
article en

Abstract

Background: Fractional flow reserve (FFR) or angiography-guided complete revascularization was not evaluated in patients with acute myocardial infarction (MI) with reduced left ventricular ejection fraction (LVEF). Objectives: To evaluate impact of FFR-guided percutaneous coronary intervention (PCI) for AMI patients with multivessel disease according to left ventricular systolic function. Methods: We performed pre-specified analysis of FRAME-AMI trial which randomly allocated 562 patients into either FFR-guided PCI (FFR≤0.80) or angiography-guided PCI (diameter stenosis of >50%) for non-infarct related artery (IRA). Patients were classified by LVEF into the preserved (LVEF ≥50%) and reduced (LVEF <50%) groups. The primary end point was patient-oriented composite outcome (POCO), a composite of death, MI, and repeat revascularization. Results: Overall, 187 patients (33.3%) had reduced LVEF. At 4-year follow-up, AMI patients with reduced LVEF showed increased risk of MACE than those with preserved LVEF (18.9% vs. 10.8%; adjusted HR=2.65, 95% CI 1.53-4.58, P<0.001). FFR-guided PCI for non-IRA significantly reduced POCO among preserved LVEF group (3.3% vs. 19.0%; adjusted HR=0.23, 95% CI 0.09-0.59, P=0.002). Conversely, there was no significant difference in POCO between FFR and angiography-guided PCI among reduced LVEF group (17.0% vs. 21.0%; HR=0.64, 95% CI 0.31-1.32, P=0.227). The prognostic impact of FFR-guided PCI tended to increase as LVEF increased (adjusted HR for POCO: 0.69 vs. 0.66 vs. 0.25 vs. 0.20, respectively, for the LVEF ≤40% vs. 40-50% vs. 50-60% vs. ≥60%, interaction P=0.028). Conclusion: In acute MI patients with multivessel disease, FFR-guided PCI for non-IRA showed differential clinical impact according to left ventricular systolic function. The beneficial effect of FFR-guided PCI might be maximized among patients with preserved LVEF rather than reduced LVEF.

CirculationVol. 150(Suppl_1)
Samsung Medical Center (KR), Gyeongsang National University Hospital (KR), Chonnam National University Hospital (KR), Veterans Health Service Medical Center (KR), Chosun University Hospital (KR), Wonju Severance Christian Hospital (KR), The Catholic University of Korea Uijeongbu St. Mary's Hospital (KR), Inje University Ilsan Paik Hospital (KR), Sejong General Hospital (KR), Inha University Hospital (KR), The Catholic University of Korea Seoul St. Mary's Hospital (KR), Keimyung University (KR)
Good health and well-being
Openalex Percentile: Top 66%
Cardiac Imaging and Diagnostics
DOISourceOpenAlex
AI Navigator

Ask Laika to Summarize, Analyze, and Connect papers live on the map.

Summarize Papers & Methodologies

Extract key findings, datasets, and comparative methods across publications.

Benchmark Rankings & Visual Analytics

Rank top research institutions, authors, funders, topics, and journals by Field-Weighted Citation Impact (FWCI) and paper volume with instant charts.

Connect Distant Disciplines

Bridge topological clusters on the map to find hidden collaborative intersections.