ACC.24 — Investigator, Dr Felix Böhm (Danderyd Hospital, SE) joins us to discuss the findings from a study investigating fractional flow reserve-guided complete or culprit-only percutaneous coronary intervention (PCI) in patients with ST-elevation myocardial infarction (MI).

1542 patients were enrolled in the trial, who were randomized 1:1 to receive either FFR-guided PCI of non-culprit lesions during index hospitalisation, or initial conservative management of non-culprit lesions. The primary endpoint was a composite of death, MI or unplanned revascularization.

Findings suggest that when compared to culprit-lesion-only PCI, FFR-guided complete non-culprit revascularization did not reduce death, MI or unplanned revascularization (HR 0.93; p=0.53). There was an observed benefit to reducing any revascularization, both planned and unplanned, however there was a higher incidence of stent thrombosis via the complete strategy. No differences in stroke, bleeding, heart failure or acute kidney injury were apparent. 

Interview Questions:

1. What is the importance of this study?
2. What was the study design and patient population?
3. What are the key findings?
4. How should these findings impact clinical practice?
5. What are your take-home messages?
6. What further study is needed?

Recorded onsite at the ACC Conference in Atlanta, 2024.

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Support: This is an independent interview conducted by Radcliffe Cardiology.

Editors: Jordan Rance, Mirjam Boros

Video Specialists: Dan Brent, Tom Green, Mike Knight