FFR-guided decision-making in patients with AMI and multivessel disease

Fractional flow reserve (FFR)-guided decision-making was superior in selective percutaneous coronary intervention (PCI) of non-infarct-related artery (IRA) lesions than routine PCI based on angiographic diameter stenosis in patients with acute myocardial infarction (MI) and multivessel disease. The results of FRAME-AMI suggest that a physiologic criterion of FFR <0.80 is superior to a qualitative angiographic criterion of luminal stenosis >50% to select non-culprit lesions in acute MI for PCI.

The FRAME-AMI trial (NCT02715518) trial, presented by Dr Joo-Yong Hahn (Samsung Medical Center, Seoul, South Korea), randomised patients from 14 Korean sites (n=562) with AMI and non-IRA lesion(s) to PCI with either FFR or angiography [1]. Patients with non-IRA lesions with an FFR <0.80 were treated with PCI (n=284) in the FFR arm of the trial, whereas patients with non-IRA lesions with estimated diameter stenosis >50% were treated with PCI in the angiography arm of the trial (n=278). The primary endpoint was a composite of all-cause death, MI, or unplanned revascularisation.

With a median follow-up of 3.5 years, the primary endpoint was met: an event occurred in 18 patients (7.4%) in the FFR arm and 40 patients (19.7%) in the angiography arm (HR 0.43; 95% CI 0.25–0.75; P=0.003). Furthermore, the rates of all-cause death (2.1% vs 8.5%), cardiac death (1.4% vs 8.2%), and MI (2.5% vs 8.9%) were significantly lower in the FFR arm than in the angiography arm.

Dr Hahn concluded: "Guidelines are unlikely to change solely based on the results of our trial, but in clinical practice, interventional cardiologists may choose to adopt FFR-guided decision-making in patients with acute MI and multivessel disease. In other words, FFR beats angiography for non-culprit lesions in patients with acute MI and multivessel disease.”

1. Hahn JY, et al. The FRAME-AMI trial - FFR vs. Angiography-guided PCI in AMI with multivessel disease. Hot Line Session 7, ESC Congress 2022, Barcelona, Spain, 26–29 August.

 

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Posted on 27 October 202226 October 2022