Comparing FFR-Guided Complete Revascularization and Conservative Management for Non-Culprit Lesions in STEMI Patients With Multivessel Disease: A Systematic Review and Meta-Analysis

In patients with ST-segment elevation myocardial infarction (STEMI) and multivessel coronary artery disease, the optimal management strategy for non-culprit lesions is a subject of ongoing debate. There has been an increasing use of physiology-guidance to assess the extent of occlusion in non-culpri...

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Veröffentlicht in:Catheterization and cardiovascular interventions 2024-12
Hauptverfasser: Gonnah, Ahmed R, Awad, Ahmed K, Helmy, Ahmed E, Elsnhory, Ahmed B, Shazly, Omar, Abousalima, Saad A, Labib, Aser, Saoudy, Hussein, Awad, Ayman K, Roberts, David H
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Sprache:eng
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Zusammenfassung:In patients with ST-segment elevation myocardial infarction (STEMI) and multivessel coronary artery disease, the optimal management strategy for non-culprit lesions is a subject of ongoing debate. There has been an increasing use of physiology-guidance to assess the extent of occlusion in non-culprit lesions, and hence the need for stenting. Fractional flow reserve (FFR) is commonly used as a technique. This analysis compares FFR versus conservative management in the management of non-culprit lesions in STEMI patients with multivessel disease. A comprehensive literature search was conducted on databases from inception to May 25, 2024. We conducted a random-effects meta-analysis using RevMan version 5.3.0, employing the Der-Simonian and Laird method to combine the data. The analysis of five RCTs including 3759 patients revealed a significantly lower incidence of major adverse cardiovascular events (composite of all-cause mortality, non-fatal myocardial infarction and the need for repeat revascularization [PCI or CABG]) in the FFR group compared to the conservative management group (RR = 0.65, 95% CI: 0.44-0.96, p = 0.03). The revascularization rates were significantly lower in the FFR group (RR = 0.53, 95% CI: 0.43-0.66, p 
ISSN:1522-1946
1522-726X
1522-726X
DOI:10.1002/ccd.31379