Can We Improve on Angiography for Guiding Nonculprit PCI in STEMI Patients?

Clinical outcomes were not improved after nonculprit-lesion PCI guided by fractional flow reserve measurement compared with angiography in patients with STEMI and multivessel disease.

In the investigator-initiated FLOWER-MI trial, roughly 1200 patients with ST-elevation myocardial infarction (STEMI) and multivessel disease who had undergone successful percutaneous coronary intervention (PCI) of the infarct-related artery were randomized to complete revascularization guided by fractional flow reserve (FFR) or angiography.

At 1-year follow-up, 5.5% of the FFR-guided group and 4.2% of the angiography-guided group had experienced a primary-outcome event of death, nonfatal MI, or unplanned, urgent revascularization (hazard ratio, 1.32; 95% CI, 0.78–2.23; P=0.31). Rates of individual primary-outcome events and other clinical events also did not differ significantly between groups.

While observing no significant benefit of the FF…

Reviewing Author

David J. Cohen, MD, MSc

Disclosures

Consultant/Advisory BoardMedtronic; Edwards Lifesciences; Abbott Vascular; Boston Scientific; St. Francis Hospital

Speaker’s BureauBoston Scientific; ZOLL Medical

Grant/Research SupportEdwards Lifesciences; Abbott Vascular; Boston Scientific; Corvia Medical; National Heart, Lung, and Blood Institute; Phillips, Inc.; St. Paul’s Hospital; V-Wave, Inc; ZOLL Medical; CathWorks, ANCORA

Editorial BoardsJACC; American Heart Journal; EuroIntervention; JSCAI; Structural Heart Journal

Leadership Positions in Professional SocietiesSociety of Thoracic Surgeons/American College of Cardiology TVT Registry (Co-Chair, Risk Model Development Committee); Cardiovascular Research Foundation (Co-Director, TCT Annual Meeting; Co-Director, New York Valves Annual Meeting)