Visual assessment of heart valve patency is not a reliable indicator of functionality; therefore, FFR can help guide appropriate decisions regarding percutaneous coronary intervention (PCI) to those vessels that genuinely need it. However, no trial has investigated the use of FFR-guided revascularisation in patients with STEMI and MVD. Thus, the FLOWER-MI study (NCT02943954) enrolled 1,163 patients who had experienced STEMI and undergone successful PCI and were judged to have at least 1 additional vessel for which revascularisation was recommended and randomised them to either angiography-guided PCI (n=577) or FFR-guided PCI (n=586).
The primary outcome was the rate of major adverse cardiovascular events (MACE) at 1 year. This outcome was met by 32 (5.5%) participants in the FFR arm and 24 (4.2%) participants in the angiography arm, yielding a hazard ratio of 1.32 (95% CI 0.78–2.23; P=0.31). These results failed to demonstrate a clear benefit of FFR-guided revascularisation over angiography-guided revascularisation in patients with STEMI and MVD at reducing the composite primary outcome of death from any cause, non-fatal MI, or hospitalisation requiring urgent revascularisation. However, the researchers caution that the wide confidence interval precludes any definitive conclusions.
- Puymirat E. Fractional Flow Reserve-guided Versus Angio-guided Multivessel Revascularization In ST-Elevation Myocardial Infarction Patients. The FLOWER-MI Randomized Trial. Abstract 407-08, ACC 2021 Scientific Session, 15-17 May.
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Table of Contents: ACC 2021
Featured articles
Electrophysiology
Favourable outcomes with transcatheter atrial appendage occlusion
Etripamil nasal spray significantly improves PSVT-related symptoms
Ablation-based rhythm control as effective as rate control in AF and HF
Finerenone reduces the risk of AF onset in patients with CKD and diabetes
Heart Failure and Cardiomyopathy
PARADISE-MI: Sacubitril/valsartan not superior to ramipril in reducing HF events
Older adults with heart failure benefit from rehabilitation programme
Quality improvement intervention fails to improve care for patients with heart failure
Sacubitril/valsartan does not reduce NT-proBNP versus valsartan alone in HFrEF
Novel use of ivabradine in reversible cardiomyopathy
Mavacamten significantly improves QoL of patients with hypertrophic cardiomyopathy
Interventional and Structural Cardiology
Men and women benefit equally from early aspirin withdrawal following PCI
Similar outcomes with fractional flow reserve and angiography-guided revascularisation
TALOS-AMI: Exploring outcomes after switching to clopidogrel versus ticagrelor at 1 month from MI
Clopidogrel monotherapy associated with better net outcomes relative to aspirin monotherapy 6-18 months after PCI
Ischaemic Heart Disease
No difference in ischaemic risk or bleeding with low vs high-dose aspirin for secondary prevention: Lessons and questions from the ADAPTABLE trial
Rivaroxaban reduces total ischaemic events after peripheral artery revascularisation
Moderate hypothermia not superior to mild hypothermia following out-of-hospital cardiac arrest
Better outcomes with invasive strategy if anatomic complete revascularisation is possible
Prevention and Health Promotion
STRENGTH trial fails to demonstrate cardioprotective effect of omega-3 fatty acids
Evinacumab lowers triglyceride levels in severe hypertriglyceridaemia
Health equity and the role of the cardiologist: 7 priorities to consider
COVID-19
Dapagliflozin fails to show a significant protective effect in COVID-19
Therapeutic anticoagulation not superior to prophylactic anticoagulation in COVID-19
Atorvastatin does not reduce mortality in COVID-19
Valvular Heart Disease
Apixaban outcomes similar to current standard of care following TAVR
Preliminary results encouraging for EVOQUE tricuspid valve replacement
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