Selective PCI of non-infarct-related artery (IRA) lesions using fractional flow reserve (FFR)-guided decision-making was superior to a strategy of routine PCI based on angiographic diameter stenosis in patients with acute myocardial infarction (AMI) and multivessel disease, according to findings from the FRAME-AMI trial presented Aug. 28 during ESC Congress 2022 in Barcelona.

The trial randomized 563 patients with AMI and non-IRA lesion(s) from 14 sites in Korea to PCI with either FFR or angiography. Patients with non-IRA lesions with an FFR of 0.80 or lower were treated with PCI (n=284) in the FFR group, while patients with non-IRA lesions with diameter stenosis >50% on visual estimation were treated with PCI in the angiography group (n=278). The primary endpoint was a composite of all-cause death, MI or unplanned revascularization. Median follow up was 3.5 years.

According to the trial investigators, non-IRA lesions were treated by immediate PCI after successful treatment of IRA in 337 patients (60.0%) and by staged procedure during the same hospitalization in 225 patients (40.0%). The primary endpoint occurred in 18 patients (7.4%) in the FFR group and 40 patients (19.7%) in the angiography group. The incidence of both death and MI was significantly lower in the FFR group compared with the angiography group (5 vs. 16 patients and 7 vs. 21, respectively). Additionally, 10 patients in the FFR group had an unplanned revascularization compared with 16 patients in the angiography group, with no significant difference between the two groups.

"The benefit of FFR-guided PCI on the primary endpoint was consistent regardless of STEMI or non-STEMI," said Joo-Yong Hahn, MD, who presented the findings. "Guidelines are unlikely to change solely based on the results of our trial, but in clinical practice, interventional cardiologists may choose to adopt FFR-guided decision-making in patients with AMI and multivessel disease."

Clinical Topics: Invasive Cardiovascular Angiography and Intervention, Stable Ischemic Heart Disease, Vascular Medicine, Interventions and Vascular Medicine, Chronic Angina

Keywords: ESC Congress, ESC22, Fractional Flow Reserve, Myocardial, Percutaneous Coronary Intervention, ST Elevation Myocardial Infarction, Constriction, Pathologic, Hospitalization, Arteries, ACC International

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