Recent studies in patients undergoing acute myocardial infarction showed that a complete revascularization strategy in an acute or subacute setting, whether it be guided through angiography (PRAMI, CvLPRIT) or fractional flow reserve (FFR) (PRIMULTI, COMPARE-ACUTE), improves the combined endpoint of major adverse cardiac events (MACE) when compared with treatment of the culprit artery only. Based on these results, the European Society of Cardiology (ESC) modified the recommendations included in its guidelines on ST-segment elevation myocardial infarction.
Now, we have the 2-year results of the COMPARE-ACUTE trial, which included patients undergoing an ST-segment elevation myocardial infarction with successful primary angioplasty of the culprit artery and other coronary lesions. These subjects were randomized to complete revascularization guided through FFR or only culprit-artery revascularization.
This study included 885 patients (295 randomized to complete FFR-guided revascularization vs. 590 randomized to culprit-artery revascularization only).
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At two years, the complete FFR-guided revascularization arm showed significant reduction in combined events (12.2% vs. 26.8%; hazard ratio [HR]: 0.41; 95% confidence interval [CI]: 0.29 to 0.59; p < 0.001). This difference was mainly driven by higher rates of repeat revascularization in the culprit-artery-only arm.
Such reduction persisted over time and does not seem to depend on the presence of lesions in 2 or 3 vessels.
Original title: Compare-Acute: Two-Year Follow-Up of Complete FFR-Guided PCI vs. Infarct-Artery-Only PCI in Multivessel STEMI Patients.
Presenter: Pieter Smits.
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