Fractional flow reserve in assessment of intermediate non-culprit lesions in acute myocardial infarction

Context: Percutaneous coronary intervention (PCI) of intermediate non-culprit arteries can reduce death or heart attack risk in patients with acute myocardial infarction and multivessel coronary artery disease. Aims: To compare the effectiveness of fractional flow reserve (FFR)-guided PCI with angiography-guided PCI for intermediate non-culprit lesions in patients with acute myocardial infarction and multivessel coronary artery disease. Methods: In this cohort study, acute myocardial infarction patients with multivessel coronary artery disease who had successful percutaneous coronary intervention of the culprit artery were divided into group of patients receiving FFR-guided PCI (FFR≤0.80, n = 31) and group of patients receiving angiography-guided PCI (diameter stenosis of 50-90%, n = 62) for lesions in non-culprit arteries. These two groups were followed for at least 1 year for major adverse cardiovascular events. Results: There was no statistically significant difference in major cardiovascular events between FFR-guided percutaneous coronary intervention group and angiography-guided percutaneous coronary intervention group. However, FFR-guided percutaneous coronary intervention group had a lower mortality rate compared to the angiography-guided percutaneous coronary intervention group (3.2% vs. 4.8%). Additionally, there were no reported cases of myocardial infarction in angiography-guided PCI group, while angiography-guided PCI group had a rate of 1.6%. Conclusions: This study found that it remains uncertain whether FFR-guided PCI is superior than angiography-guided PCI for intermediate non-culprit lesions in patients with acute myocardial infarction and multivessel coronary artery disease.