Article Dans Une Revue Circulation: Cardiovascular Interventions Année : 2024

Three-Year Outcomes With Fractional Flow Reserve–Guided or Angiography-Guided Multivessel Percutaneous Coronary Intervention for Myocardial Infarction

1 HEGP - Hôpital Européen Georges Pompidou [APHP]
2 UPCité - Université Paris Cité
3 FACT - Alliance française pour les essais cliniques cardio-vasculaires - French Alliance for Cardiovascular Trials
4 CHU Nîmes - Centre Hospitalier Universitaire de Nîmes
5 UM - Université de Montpellier
6 CHU Saint-Antoine [AP-HP]
7 LVTS (UMR_S_1148 / U1148) - Laboratoire de Recherche Vasculaire Translationnelle
8 AP-HP - Hôpital Bichat - Claude Bernard [Paris]
9 SU - Sorbonne Université
10 CHU Pitié-Salpêtrière [AP-HP]
11 Groupe Action
12 ICAN - Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Research Unit on Cardiovascular and Metabolic Diseases
13 Institut de cardiologie [CHU Pitié-Salpêtrière]
14 Hôpital Hôtel-Dieu [Paris]
15 Service de Cardiologie [CHU Henri Mondor]
16 IMRB - Institut Mondor de Recherche Biomédicale
17 ENVA - École nationale vétérinaire d'Alfort
18 CHR Metz-Thionville - Centre hospitalier régional de Metz-Thionville
19 [Clinique Saint-Martin, Caen] - Hôpital Privé Saint-Martin [Caen]
20 Service Cardiologie Médicale et Médecine Vasculaire [CHU Clermont-Ferrand]
21 UCA - Université Clermont Auvergne
22 Institut Coeur Poumon [CHU Lille]
23 RNMCD - Récepteurs Nucléaires, Maladies Métaboliques et Cardiovasculaires - U 1011
24 MASCOT (UMR_S_942 / U942) - Marqueurs cardiovasculaires en situation de stress
25 Hôpital Lariboisière-Fernand-Widal [APHP]
26 Service Cardiologie [CHU Toulouse]
27 UTPS - Université Toulouse III Paul Sabatier - Faculté de médecine Purpan
28 Service de cardiologie et de pathologie vasculaire [CHU Caen]
29 CHCB - Centre Hospitalier de la Côte Basque
30 Hôpitaux de Chartres [Chartres]
31 Service de Chirurgie Thoracique et Vasculaire [Hôpital Bichat]
32 PEC2 - Physiopathologie et épidémiologie cérébro-cardiovasculaires [Dijon]
33 Service de Cardiologie [CHU de Dijon]
34 CIC 1418 - CIC - HEGP
Isabelle Durand-Zaleski
Grégoire Rangé
Anais Charles-Nelson
Juliette Djadi-Prat
Gilles Chatellier

Résumé

BACKGROUND: In patients with multivessel disease with successful primary percutaneous coronary intervention for ST-segment–elevation myocardial infarction, the FLOWER-MI trial (Flow Evaluation to Guide Revascularization in Multivessel ST-Elevation Myocardial Infarction) showed that a fractional flow reserve (FFR)–guided strategy was not superior to an angiography-guided strategy for treatment of noninfarct-related artery lesions regarding the 1-year risk of death from any cause, myocardial infarction, or unplanned hospitalization leading to urgent revascularization. The extension phase of the trial was planned using the same primary outcome to determine whether a difference in outcomes would be observed with a longer follow-up. METHODS: In this multicenter trial, we randomly assigned patients with ST-segment–elevation myocardial infarction and multivessel disease with successful percutaneous coronary intervention of the infarct-related artery to receive complete revascularization guided by either FFR (n=586) or angiography (n=577). RESULTS: After 3 years, a primary outcome event occurred in 52 of 498 patients (9.40%) in the FFR-guided group and in 44 of 502 patients (8.17%) in the angiography-guided group (hazard ratio, 1.19 [95% CI, 0.79–1.77]; P =0.4). Death occurred in 22 patients (4.00%) in the FFR-guided group and in 23 (4.32%) in the angiography-guided group (hazard ratio, 0.96 [95% CI, 0.53–1.71]); nonfatal myocardial infarction in 23 (4.13%) and 14 (2.56%), respectively (hazard ratio, 1.63 [95% CI, 0.84–3.16]); and unplanned hospitalization leading to urgent revascularization in 21 (3.83%) and 18 (3.36%; hazard ratio, 1.15 [95% CI, 0.61–2.16]), respectively. CONCLUSIONS: Although event rates in the trial were lower than expected, in patients with ST-segment–elevation myocardial infarction undergoing complete revascularization, an FFR-guided strategy did not have a significant benefit over an angiography-guided strategy with respect to the risk of death, myocardial infarction, or urgent revascularization up to 3 years. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT02943954.

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Dates et versions

hal-05068047 , version 1 (14-05-2025)

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Citer

Etienne Puymirat, Guillaume Cayla, Tabassome Simon, Philippe Gabriel Steg, Gilles Montalescot, et al.. Three-Year Outcomes With Fractional Flow Reserve–Guided or Angiography-Guided Multivessel Percutaneous Coronary Intervention for Myocardial Infarction. Circulation: Cardiovascular Interventions, 2024, 17 (6), pp.e013913. ⟨10.1161/CIRCINTERVENTIONS.123.013913⟩. ⟨hal-05068047⟩
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