Angiography-based visual assessment of the degree of coronary artery stenosis is not a reliable indicator of haemodynamically significant obstruction; therefore, FFR can help guide appropriate decisions regarding percutaneous coronary intervention (PCI) of those vessels with significant lesions. However, trials investigating the use of FFR-guided revascularisation in patients with STEMI and MVD were lacking. To this end, the FLOWER-MI study (NCT02943954) randomised 1,163 patients to either angiography-guided PCI (n=577) or FFR-guided PCI (n=586). The study enrolled participants with STEMI who had undergone successful PCI and were judged to have at least 1 additional non-culprit lesion for which revascularisation could be recommended.
The primary outcome was the rate of major adverse cardiovascular events (i.e. composite of all-cause mortality, non-fatal myocardial infarction, and unplanned hospitalisation resulting in urgent revascularisation) at 1 year. This outcome occurred in 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) (see Figure).
Figure: Primary outcome (MACE at 1 year) in the FLOWER-MI trial. Adapted from [2]
Angio, angiography; CI, confidence interval; HR, hazard ratio; FFR, fractional flow reserve; MACE, major adverse cardiac events; PCI, percutaneous coronary intervention.
These results failed to demonstrate a benefit of FFR-guided revascularisation over angiography-guided revascularisation in patients with STEMI and MVD in reducing major adverse cardiovascular events. 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 Randomised Trial. Abstract 407-08, ACC 2021 Scientific Session, 15–17 May.
- Puymirat E. N Engl J Med 2021;May 16. DOI:10.1056/NEJMoa2104650.
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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
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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
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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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