6/28/23, 12:28 AM Compare-Acute Pathway Feedback Search Clinical Topics Home Studies Compare-Acute Compare-Acute Disease Disease Coronary artery disease ST-elevation myocardial infarction Trial question What is the effect of fractional flow reserve-guided multivessel angioplasty in patients with ST- segment elevation myocardial infarction and multivessel disease who underwent primary PCI of an infarct-related coronary artery? Study design Multi-center Single blinded RCT Population Characteristics of study participants 23.0% female N = 885 77.0% male 885 patients (202 female, 683 male) Inclusion criteria: patients with STEMI and multivessel disease who had undergone primary PCI of an infarct-related coronary artery Key exclusion criteria: left main coronary artery disease, chronic total occlusion, severe stenosis, with a Thrombolysis in Myocardial Infarction (TIMI) flow grade of 2 in the non- infarct-related coronary artery, suboptimal result or complications after treatment of an infarct- related coronary artery, severe valve dysfunction, and Killip class III or IV Interventions N=295 complete percutaneous coronary revascularization (fractional flow reserve-guided complete revascularization of non-infarct-related coronary arteries) N=590 infarct artery-only percutaneous coronary revascularization (no revascularization of non-infarct-related coronary arteries) https://web.pathway.md/studies/rectwLE3jzavGquyC 1/2 6/28/23, 12:28 AM Compare-Acute Pathway Primary outcome All-cause death, nonfatal myocardial infarction, revascularization and cerebrovascular events at 12 months 20.5 % 20.5 15.4 % 10.3 % Significant decrease 7.8 5.1 % NNT = 8 0.0 % Complete percutaneous coronary revascularization Infarct artery-only percutaneous coronary revascularization Significant decrease in all-cause death, nonfatal myocardial infarction, revascularization and cerebrovascular events at 12 months (7.8% vs. 20.5%; HR 0.35, 95% CI 0.22 to 0.55) Secondary outcomes No significant difference in death from any cause (1.4% vs. 1.7%; HR 0.8, 95% CI 0.25 to 2.56) Safety outcomes Significant difference in FFR-related serious adverse event (0 vs. 0.2%). Conclusion In patients with STEMI and multivessel disease who had undergone primary PCI of an infarct- related coronary artery, complete percutaneous coronary revascularization was superior to infarct artery-only percutaneous coronary revascularization with respect to a all-cause death, nonfatal myocardial infarction, revascularization and cerebrovascular events at 12 months. Reference Smits PC, Abdel-Wahab M, Neumann FJ et al. Fractional Flow Reserve-Guided Multivessel Angioplasty in Myocardial Infarction. N Engl J Med. 2017 Mar 30;376(13):1234-1244. Open reference URL https://web.pathway.md/studies/rectwLE3jzavGquyC 2/2