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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
FFR- Versus Angiography-Guided Revascularization for Nonculprit Stenosis in STEMI and Multivessel Disease: A Network Meta-Analysis
JACC: Cardiovascular Interventions, Volume 15, No. 6, Year 2022
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Description
Objectives: The aim of this study was to examine the efficacy and safety of fractional flow reserve (FFR)–guided versus angiography-guided approaches for nonculprit stenosis among patients with acute ST-segment elevation myocardial infarction (STEMI) and multivessel disease. Background: The optimal strategy to guide revascularization of nonculprit stenosis among patients with STEMI and multivessel disease remains uncertain. Methods: Electronic databases were searched for randomized trials evaluating the outcomes of culprit-only revascularization, angiography-guided complete revascularization (CR), or FFR-guided CR. A pairwise meta-analysis comparing CR versus culprit-only revascularization and a network meta-analysis comparing the different revascularization techniques were conducted. The primary outcome was major adverse cardiac events (MACE). Results: The analysis included 11 trials with 8,195 patients. CR (ie, angiography-guided or FFR-guided CR) was associated with a lower incidence of MACE (odds ratio [OR]: 0.46; 95% CI: 0.35 to 0.59), cardiovascular mortality (OR: 0.63; 95% CI: 0.41 to 0.98), recurrent myocardial infarction (OR: 0.67; 95% CI: 0.48 to 0.95), and repeat ischemia-driven revascularization (OR: 0.26; 95% CI: 0.19 to 0.35). Network meta-analysis demonstrated that the incidence of MACE was lower with both angiography-guided CR (OR: 0.43; 95% CI: 0.31 to 0.58) and FFR-guided CR (OR: 0.52; 95% CI: 0.35 to 0.78) compared with a culprit-only approach, while there was no difference in risk for MACE between angiography-guided and FFR-guided CR (OR: 0.81; 95% CI: 0.51 to 1.29). Conclusions: Among patients with STEMI and multivessel disease, CR, with angiographic or FFR guidance for nonculprit stenosis, was associated with lower incidence of adverse events compared with culprit-only revascularization. FFR-guided CR was not superior to angiography-guided CR in reducing the incidence of adverse events. Future studies investigating other tools to risk-stratify nonculprit stenoses are encouraged. © 2022 American College of Cardiology Foundation
Authors & Co-Authors
Elbadawi, Ayman
United States, Houston
Baylor College of Medicine
Hamed, Mohamed
United States, Boca Raton
Florida Atlantic University
Saleh, Mohammed
United States, Galveston
The University of Texas Medical Branch at Galveston
Gad, Mohamed M.
United States, Cleveland
Cleveland Clinic Foundation
Mamas, Mamas Andreas
United Kingdom, Keele
Keele University
United Kingdom, Stoke-on-trent
Royal Stoke University Hospital
Elgendy, Islam Y.
Qatar, Doha
Weill Cornell Medicine-qatar
Statistics
Citations: 19
Authors: 6
Affiliations: 9
Identifiers
Doi:
10.1016/j.jcin.2022.01.002
ISSN:
19368798
Research Areas
Noncommunicable Diseases
Study Design
Cohort Study
Case-Control Study
Study Approach
Systematic review