Clinical Relevance of Fractional Flow Reserve‐Guided Percutaneous Coronary Intervention According to Left Ventricular Ejection Fraction in Patients With Acute Myocardial Infarction and Multivessel Disease
Year: 2025
Type: article
Abstract: Background Fractional flow reserve (FFR)‐guided or angiography‐guided complete revascularization has not been evaluated in patients with acute myocardial infarction (AMI) with multivessel disease and reduced left ventricular ejection fraction (LVEF). This study sought to evaluate the impact of FFR‐guided percutaneous coronary intervention (PCI) for patients with AMI with multivessel disease according to left ventricular systolic function. Methods We performed a prespecified analysis of the FRAME‐AMI (Fractional Flow Reserve Versus Angiography‐Guided Strategy in Acute Myocardial Infarction With Multivessel Disease) trial, which randomly allocated 562 patients to undergo either FFR‐guided PCI (FFR ≤0.80) or angiography‐guided PCI (diameter stenosis >50%) for non–infarct‐related arteries. Patients were classified into preserved (≥50%) and reduced (<50%) LVEF groups. Primary end point was major adverse cardiovascular events, a composite of death, myocardial infarction, and repeat revascularization. Results Overall, 187 patients (33.3%) had reduced LVEF. During a median 3.5‐year follow‐up, patients with AMI with reduced LVEF showed an increased risk of major adverse cardiovascular events compared with those with preserved LVEF ( P <0.001). FFR‐guided PCI for non–infarct‐related arteries significantly reduced major adverse cardiovascular events among patients with preserved LVEF (3.3% versus 19.0%; hazard ratio [HR], 0.26 [95% CI, 0.11–0.66]; P =0.004). Conversely, there was no significant difference in major adverse cardiovascular events between the FFR and angiography‐guided PCI among patients with reduced LVEF (17.0% versus 21.0%; HR, 0.64 [95% CI, 0.31–1.31]; P =0.225). In the exploratory analysis, the clinical benefit of FFR‐guided PCI was more evident with an increased LVEF (interaction P =0.028). Conclusions In patients with AMI with multivessel disease, FFR‐guided PCI for a non–infarct‐related artery had 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. Registration URL: https://clinicaltrials.gov . Unique identifier: NCT02715518.
Authors: Seung Hun Lee, Seung Hun Lee, Hangyul Kim, Hangyul Kim, Joo Myung Lee, Joon Ho Ahn, Seongho Park, Yong‐Kyu Lee, Donghyeon Joo, Kyung Hoo Cho, Min Chul Kim, Doo Sun Sim, Hyun Kuk Kim, Hyun Kuk Kim, Keun‐Ho Park, Eun Ho Choo, Chan Joon Kim, Sung Gyun Ahn, Joon‐Hyung Doh, Sang Yeub Lee, Sang Yeub Lee, Sang Don Park, Hyun‐Jong Lee, Min Gyu Kang, Chang‐Wook Nam, David Hong, Hyun Sung Joh, Ki Hong Choi, Taek Kyu Park, Jeong Hoon Yang, Young Bin Song, Seung‐Hyuk Choi, Ju Han Kim, Youngkeun Ahn, Myung Ho Jeong, Hyeon‐Cheol Gwon, Joo‐Yong Hahn, Jin‐Sin Koh, Young Joon Hong, the FRAME‐AMI Investigators
Institutions: Chonnam National University, Chonnam National University Hospital, Chung-Ang University Gwangmyeong Hospital, Gyeongsang National University, Gyeongsang National University Hospital, Chosun University, Samsung Medical Center, Sungkyunkwan University, Inha University Hospital, Chosun University Hospital, The Catholic University of Korea Seoul St. Mary's Hospital, Catholic University of Korea, The Catholic University of Korea Uijeongbu St. Mary's Hospital, Yonsei University, Wonju Severance Christian Hospital, Inje University Ilsan Paik Hospital, Sejong General Hospital, Keimyung University Dongsan Medical Center, Keimyung University Dongsan Hospital, Seoul National University, SNUH SMG-SNU Boramae Medical Center
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,810
Funder: Chonnam National University
OpenAlex ID: W4413835937