Compared Outcomes of ST-Elevation Myocardial Infarction Patients with Multivessel Disease Treated with Primary Percutaneous Coronary Intervention and Preserved Fractional Flow Reserve of Non-Culprit Lesions Treated Conservatively and of Those with Low Fractional Flow Reserve Managed Invasively: Insights from the FLOWER MI trial. - CNRS - Centre national de la recherche scientifique Accéder directement au contenu
Article Dans Une Revue Circulation: Cardiovascular Interventions Année : 2021

Compared Outcomes of ST-Elevation Myocardial Infarction Patients with Multivessel Disease Treated with Primary Percutaneous Coronary Intervention and Preserved Fractional Flow Reserve of Non-Culprit Lesions Treated Conservatively and of Those with Low Fractional Flow Reserve Managed Invasively: Insights from the FLOWER MI trial.

1 HEGP - Hôpital Européen Georges Pompidou [APHP]
2 CHU Saint-Antoine [AP-HP]
3 UPMC - Université Pierre et Marie Curie - Paris 6
4 LBPC (U698) - Hémostase, bio-ingénierie et remodelage cardiovasculaires
5 CHU Nîmes - Centre Hospitalier Universitaire de Nîmes
6 UM - Université de Montpellier
7 LVTS (UMR_S_1148 / U1148) - Laboratoire de Recherche Vasculaire Translationnelle
8 AP-HP - Hôpital Bichat - Claude Bernard [Paris]
9 FACT - Alliance française pour les essais cliniques cardio-vasculaires - French Alliance for Cardiovascular Trials
10 UPCité - Université Paris Cité
11 SU - Sorbonne Université
12 ICAN - Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Research Unit on Cardiovascular and Metabolic Diseases
13 Hôpital Hôtel-Dieu [Paris]
14 LTSI - Laboratoire Traitement du Signal et de l'Image
15 UR - Université de Rennes
16 Centre Hospitalier Universitaire de Rennes [CHU Rennes] = Rennes University Hospital [Ponchaillou]
17 CHU La Rochelle - Service de Cardiologie La Rochelle
18 CHRU Besançon - Centre Hospitalier Régional Universitaire de Besançon
19 PCVP / CARDIO - Marqueurs pronostiques et facteurs de régulations des pathologies cardiaques et vasculaires - UFC ( UR 3920)
20 NORT - Nutrition, obésité et risque thrombotique
21 TIMONE - Hôpital de la Timone [CHU - APHM]
22 AMU - Aix Marseille Université
23 C2VN - Centre recherche en CardioVasculaire et Nutrition = Center for CardioVascular and Nutrition research
24 LRB - Radiopharmaceutiques biocliniques
25 CHUGA - Centre Hospitalier Universitaire [CHU Grenoble]
26 UGA - Université Grenoble Alpes
27 CHU de Poitiers - Centre hospitalier universitaire de Poitiers = Poitiers University Hospital
28 Centre Hospitalier Sud Francilien
29 Groupe Hospitalier Intercommunal Le Raincy-Montfermeil
30 T2i - Transplantation, Immunologie, Inflammation [Tours]
31 CHU Trousseau [Tours]
32 UT - Université de Tours
33 PhyMedExp - Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046]
34 CHRU Montpellier - Centre Hospitalier Régional Universitaire [Montpellier]
35 CIC 1418 - CIC - HEGP
Anaïs Charles-Nelson
  • Fonction : Auteur
Gilles Chatellier

Résumé

Background - In patients with ST-segment-elevation myocardial infarction and multivessel disease, percutaneous coronary intervention (PCI) for nonculprit lesions guided by fractional flow reserve (FFR) is superior to treatment of the culprit lesion alone. Whether deferring nonculprit PCI is safe in this specific context is questionable. We aimed to assess clinical outcomes at 1 year in ST-segment-elevation myocardial infarction patients with multivessel coronary artery disease and an FFR-guided strategy for nonculprit lesions, according to whether or not ≥1 PCI was performed. Methods - Outcomes were analyzed in patients of the randomized FLOWER-MI (Flow Evaluation to Guide Revascularization in Multivessel ST-Elevation Myocardial Infarction) trial in whom, after successful primary PCI, nonculprit lesions were assessed using FFR. The primary outcome was a composite of all-cause death, nonfatal myocardial infarction, and unplanned hospitalization with urgent revascularization at 1 year. Results - Among 1171 patients enrolled in this study, 586 were assigned to the FFR-guided group: 388 (66%) of them had ≥1 PCI, and 198 (34%) had no PCI. Mean FFR before decision (ie, PCI or not) of nonculprit lesions was 0.75±0.10 and 0.88±0.06, respectively. During follow-up, a primary outcome event occurred in 16 of 388 patients (4.1%) in patients with PCI and in 16 of 198 patients (8.1%) in patients without PCI (adjusted hazard ratio, 0.42 [95% CI, 0.20-0.88]; =0.02). Conclusions - In patients with ST-segment-elevation myocardial infarction undergoing complete revascularization guided by FFR measurement, those with ≥1 PCI had lower event rates at 1 year, compared with patients with deferred PCI, suggesting that deferring lesions judged relevant by visual estimation but with FFR >0.80 may not be optimal in this context. Future randomized studies are needed to confirm these data. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT02943954. Graphic Abstract: A graphic abstract is available for this article.
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hal-03327827 , version 1 (29-08-2021)

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Pierre Denormandie, Tabassome Simon, Guillaume Cayla, Philippe Gabriel Steg, Gilles Montalescot, et al.. Compared Outcomes of ST-Elevation Myocardial Infarction Patients with Multivessel Disease Treated with Primary Percutaneous Coronary Intervention and Preserved Fractional Flow Reserve of Non-Culprit Lesions Treated Conservatively and of Those with Low Fractional Flow Reserve Managed Invasively: Insights from the FLOWER MI trial.. Circulation: Cardiovascular Interventions, 2021, 14 (11), pp.e011314. ⟨10.1161/CIRCINTERVENTIONS.121.011314⟩. ⟨hal-03327827⟩
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