Immediate versus staged complete myocardial revascularization in patients with ST-segment elevation myocardial infarction and multivessel disease: a post hoc analysis of the randomized FLOWER-MI trial - Archive ouverte HAL Accéder directement au contenu
Article Dans Une Revue Archives of cardiovascular diseases Année : 2022

Immediate versus staged complete myocardial revascularization in patients with ST-segment elevation myocardial infarction and multivessel disease: a post hoc analysis of the randomized FLOWER-MI trial

1 HEGP - Hôpital Européen Georges Pompidou [APHP]
2 Hôpital privé Saint-Martin - Ramsay Santé
3 Service de Cardiologie [Henri Mondor]
4 U955 Inserm - UPEC - IMRB - "Biologie du système neuromusculaire" [Créteil]
5 CHU Nîmes - Centre Hospitalier Universitaire de Nîmes
6 FACT - Alliance française pour les essais cliniques cardio-vasculaires - French Alliance for Cardiovascular Trials
7 Pole Cardio-vasculaire et pulmonaire [CHU Lille]
8 RNMCD - Récepteurs Nucléaires, Maladies Métaboliques et Cardiovasculaires - U1011
9 Service Cardiologie [CHU Toulouse]
10 UT3 - Université Toulouse III - Paul Sabatier
11 MASCOT (UMR_S_942 / U942) - Marqueurs cardiovasculaires en situation de stress
12 Service de Chirurgie Thoracique et Vasculaire [Hôpital Bichat]
13 LVTS (UMR_S_1148 / U1148) - Laboratoire de Recherche Vasculaire Translationnelle
14 CHU Trousseau [Tours]
15 PEC2 - Physiopathologie et épidémiologie cérébro-cardiovasculaire [Dijon]
16 Service de Cardiologie [CHU de Dijon]
17 Hôpital Hôtel-Dieu [Paris]
18 CHU Pitié-Salpêtrière [AP-HP]
19 Groupe Action
20 ICAN - Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Research Unit on Cardiovascular and Metabolic Diseases
21 CIC 1418 - CIC - HEGP
22 CIC Paris-Est - Centre d'investigation clinique Paris Est [CHU Pitié Salpêtrière]
23 UPMC - Unité de recherche Phytopharmacie et Médiateurs Chimiques
24 LBPC (U698) - Hémostase, bio-ingénierie et remodelage cardiovasculaires
Anaïs Charles Nelson
  • Fonction : Auteur
Gilles Chatellier

Résumé

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.

Dates et versions

hal-04002192 , version 1 (23-02-2023)

Identifiants

Citer

Victoria Tea, Jean-François Morelle, Romain Gallet, Guillaume Cayla, Gilles Lemesle, et al.. Immediate versus staged complete myocardial revascularization in patients with ST-segment elevation myocardial infarction and multivessel disease: a post hoc analysis of the randomized FLOWER-MI trial. Archives of cardiovascular diseases, 2022, 115 (10), pp.496-504. ⟨10.1016/j.acvd.2022.05.011⟩. ⟨hal-04002192⟩
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