TY - JOUR
T1 - Immediate versus staged complete myocardial revascularization in patients with ST-segment elevation myocardial infarction and multivessel disease
T2 - A post hoc analysis of the randomized FLOWER-MI trial
AU - Tea, Victoria
AU - Morelle, Jean François
AU - Gallet, Romain
AU - Cayla, Guillaume
AU - Lemesle, Gilles
AU - Lhermusier, Thibault
AU - Dillinger, Jean Guillaume
AU - Ducrocq, Grégory
AU - Angouvant, Denis
AU - Cottin, Yves
AU - Chamandi, Chekrallah
AU - le Bras, Alicia
AU - Steg, Philippe Gabriel
AU - Montalescot, Gilles
AU - Nelson, Anaïs Charles
AU - Simon, Tabassome
AU - Chatellier, Gilles
AU - Danchin, Nicolas
AU - Puymirat, Etienne
AU - for the FLOWER-MI Study Investigators
N1 - Funding Information:
FLOWER-MI is an academic study, funded by a grant from the “Programme Hospitalier de Recherche Clinique” (PHRC) issued by the French Ministry of Health. The study was sponsored by Assistance Publique–Hôpitaux de Paris, with an unrestricted grant from Abbott, which provided the coronary pressure guidewire (Radi Medical Systems). The authors are solely responsible for the design and conduct of this study, all study analyses, the drafting and editing of the paper and its final contents. None of the funders had a role in the design and conduct of the study or in the data collection and management.
Publisher Copyright:
© 2022 Elsevier Masson SAS
PY - 2022/10
Y1 - 2022/10
N2 - Background: In patients with ST-segment elevation myocardial infarction and multivessel disease, percutaneous coronary intervention for non-culprit lesions is superior to treatment of the culprit lesion alone. The optimal timing for non-infarct-related artery revascularization – immediate versus staged – has not been investigated adequately. Aim: We aimed to assess clinical outcomes at 1 year in patients with ST-segment elevation myocardial infarction with multivessel disease using immediate versus staged non-infarct-related artery revascularization. Methods: Outcomes were analysed in patients from the randomized FLOWER-MI trial, in whom, after successful primary percutaneous coronary intervention, non-culprit lesions were assessed using fractional flow reserve or angiography during the index procedure or during a staged procedure during the initial hospital stay, ≤ 5 days after the index procedure. The primary outcome was a composite of all-cause death, non-fatal myocardial infarction and unplanned hospitalization with urgent revascularization at 1 year. Results: Among 1171 patients enrolled in this study, 1119 (96.2%) had complete revascularization performed during a staged procedure, and 44 (3.8%) at the time of primary percutaneous coronary intervention. During follow-up, a primary outcome event occurred in one of the patients (2.3%) with an immediate strategy and in 55 patients (4.9%) with a staged strategy (adjusted hazard ratio 1.44, 95% confidence interval 0.39–12.69; P = 0.64). Conclusions: Staged non-infarct-related artery complete revascularization was the strategy preferred by investigators in practice in patients with ST-segment elevation myocardial infarction with multivessel disease. This strategy was not superior to immediate revascularization, which, in the context of this trial, was used in a small proportion of patients. Further randomized studies are needed to confirm these observational findings.
AB - Background: In patients with ST-segment elevation myocardial infarction and multivessel disease, percutaneous coronary intervention for non-culprit lesions is superior to treatment of the culprit lesion alone. The optimal timing for non-infarct-related artery revascularization – immediate versus staged – has not been investigated adequately. Aim: We aimed to assess clinical outcomes at 1 year in patients with ST-segment elevation myocardial infarction with multivessel disease using immediate versus staged non-infarct-related artery revascularization. Methods: Outcomes were analysed in patients from the randomized FLOWER-MI trial, in whom, after successful primary percutaneous coronary intervention, non-culprit lesions were assessed using fractional flow reserve or angiography during the index procedure or during a staged procedure during the initial hospital stay, ≤ 5 days after the index procedure. The primary outcome was a composite of all-cause death, non-fatal myocardial infarction and unplanned hospitalization with urgent revascularization at 1 year. Results: Among 1171 patients enrolled in this study, 1119 (96.2%) had complete revascularization performed during a staged procedure, and 44 (3.8%) at the time of primary percutaneous coronary intervention. During follow-up, a primary outcome event occurred in one of the patients (2.3%) with an immediate strategy and in 55 patients (4.9%) with a staged strategy (adjusted hazard ratio 1.44, 95% confidence interval 0.39–12.69; P = 0.64). Conclusions: Staged non-infarct-related artery complete revascularization was the strategy preferred by investigators in practice in patients with ST-segment elevation myocardial infarction with multivessel disease. This strategy was not superior to immediate revascularization, which, in the context of this trial, was used in a small proportion of patients. Further randomized studies are needed to confirm these observational findings.
KW - Acute myocardial infarction
KW - Fractional flow reserve
KW - Multivessel disease
UR - http://www.scopus.com/inward/record.url?scp=85137635866&partnerID=8YFLogxK
U2 - 10.1016/j.acvd.2022.05.011
DO - 10.1016/j.acvd.2022.05.011
M3 - Article
C2 - 36096979
AN - SCOPUS:85137635866
VL - 115
SP - 496
EP - 504
JO - Archives of Cardiovascular Diseases
JF - Archives of Cardiovascular Diseases
SN - 1875-2136
IS - 10
ER -