# Fractional flow reserve-guided complete vs. culprit-only revascularization in ST-elevation myocardial infarction patients with multivessel disease: a meta-analysis

## TL;DR

This study finds that using fractional flow reserve to guide complete revascularization in heart attack patients with multiple blocked arteries may reduce major cardiac events compared to treating only the main blockage.

## Contribution

The study provides a meta-analysis comparing FFR-guided complete revascularization to culprit-only revascularization in STEMI patients with multivessel disease.

## Key findings

- FFR-guided complete revascularization reduces major adverse cardiac events compared to culprit-only revascularization.
- It significantly lowers ischemia-driven revascularization and repeat percutaneous coronary interventions.
- No difference in all-cause mortality was observed between the two approaches.

## Abstract

Among patients with ST-elevation myocardial infarction (STEMI) and multivessel disease, whether fractional flow reserve (FFR) guided complete revascularization (CR) is superior to the now widely used culprit-only (COR) revascularization is unclear.

We conducted a search of PubMed, Embase, the Cochrane Library, and CNKI for randomized controlled trials comparing FFR-guided CR with COR in STEMI patients with multivessel disease. Data extraction and analysis adhered to Cochrane guidelines, with major adverse cardiac events as the primary outcome.

This meta-analysis included 6 trials involving 3,482 patients. FFR-guided CR was associated with a reduction in major adverse cardiac events (RR: 0.66, 95% CI: 0.46–0.94, 95% PI: 0.20–2.19), ischemia-driven revascularization (RR: 0.27, 95% CI: 0.19–0.40, 95% PI: 0.16–0.46), and repeat percutaneous coronary interventions (RR: 0.35, 95% CI: 0.22–0.50, 95% PI: 0.16–0.78) compared to COR. However, no difference was observed in all-cause mortality (RR: 1.12, 95% CI: 0.86–1.46, 95% PI: 0.79–1.58) or safety outcomes.

FFR-guided CR reduces major adverse cardiac events compared to COR, though benefits may vary across settings. It significantly lowers ischemia-driven revascularization and repeat percutaneous coronary interventions, with no difference in all-cause mortality compared to COR.

https://www.crd.york.ac.uk/PROSPERO/view/CRD42024567524, PROSPERO (CRD42024567524).