STAGED MYOCARDIAL REVASCULARIZATION IN PATIENTS WITH ST-SEGMENT ELEVATION MYOCARDIAL INFARCTION AND MULTIVESSEL CORONARY ARTERY DISEASE BASED ON CORONARY PHYSIOLOGY PARAMETERS IN NON-INFARCT-RELATED ARTERIES: ANALYSIS OF OUTCOMES ACCORDING TO MID-TERM FOLLOW-UP

Abstract

Highlights The study demonstrates that in patients with uncomplicated STEMI and intermediate stenoses of non-infarct-related arteries, performing staged complete revascularization only with a hemodynamically significant fractional flow reserve (FFR) value ≤ 0.80 at 30–45 days after primary intervention is associated with no cases of cardiovascular death and recurrent myocardial infarction over a median follow-up of 21 months. The uniqueness of the approach lies in the selection of hemodynamically significant stenoses, which avoided excessive stenting in 40% of patients without worsening prognosis. Thus, the work makes an important contribution to the rationale for FFR-guided staged complete revascularization in STEMI patients with multivessel coronary artery disease.   Aim.  To evaluate the incidence of major adverse cardiovascular events in patients with ST-segment elevation myocardial infarction (STEMI) and multivessel disease after staged complete revascularization of non-infarct-related arteries (non-IRAs) guided by fractional flow reserve (FFR). Methods.  This single-center prospective study included 52 patients with STEMI and intermediate non-IRA stenoses (50–85%). All patients underwent primary percutaneous coronary intervention of the infarct-related artery. At 30–45 days, FFR assessment in non-IRAs was performed; revascularization was performed when FFR ≤ 0.80. Median follow-up was 21 months. The primary endpoint was cardiovascular death and recurrent myocardial infarction. Results.  Hemodynamically significant stenoses were identified in 31 patients (59.6%), who underwent stenting; 21 patients (40.4%) received only medical therapy. During the follow-up period, no cases of cardiovascular death or recurrent myocardial infarction were recorded (0%; 95% CI 0.0–5.6%). Repeat revascularization was performed in 4 patients (7.7%), and 2 cases of non-cardiovascular death (3.8%) were recorded. No cases of contrast-induced nephropathy, clinically significant bleeding, or stroke were observed. Conclusion.  In patients with uncomplicated STEMI and intermediate non-IRA stenoses, an FFR-guided staged complete revascularization strategy performed at 30–45 days after primary intervention was associated with a low incidence of cardiovascular events; no cases of cardiovascular death or recurrent myocardial infarction were recorded in this cohort. This approach avoids excessive stenting but requires confirmation in larger studies.