Highlights from

ACC 2021

American College of Cardiology Annual Congress 2021

Virtual 15-17 May 2021

Similar outcomes fractional flow reserve and angiography-guided revascularisation

Summary: Fractional flow reserve (FFR)-guided revascularisation did not demonstrate any benefit over angiography-guided revascularisation in the FLOWER-MI trial that compared these procedures.1 In patients with ST-elevated myocardial infarction (STEMI) and multi-vessel disease (MVD), complete vascularisation is associated with better clinical outcomes than vascularisation of only the culprit lesion. While current guidelines recommend the use of FFR to treat culprit lesions in patients with STEMI and MVD, it is unclear if FFR will also afford superior clinical outcomes when used in non-culprit lesions.

Visual assessment of heart valve patency is not a reliable indicator of functionality; therefore, FFR can help guide appropriate decisions regarding percutaneous coronary intervention (PCI) to those vessels that genuinely need it. However, no trial has investigated the use of FFR-guided revascularisation in patients with STEMI and MVD. Thus, the FLOWER-MI study (NCT02943954) enrolled 1,163 patients who had experienced STEMI and undergone successful PCI and were judged to have at least one additional vessel for which revascularisation was recommended and randomised them to either angiography-guided PCI (n=577) or FFR-guided PCI (n=586). The primary outcome was the rate of major adverse cardiovascular events (MACE) at 1 year. This outcome was met by 32 (5.5%) participants in the FFR arm and 24 (4.2%) participants in the angiography arm, yielding a hazard ratio of 1.32 (95% CI 0.78–2.23; P=0.31). These results failed to demonstrate a clear benefit of FFR-guided revascularisation over angiography-guided revascularisation in patients with STEMI and MVD at reducing the composite primary outcome of death from any cause, non-fatal MI, or hospitalisation requiring urgent revascularisation. However, the researchers caution that the wide confidence interval precludes any definitive conclusions.

  1. Puymirat E. Fractional flow reserve-guided versus angio-guided multivessel revascularization in ST-elevation myocardial infarction patients. The FLOWER-MI Randomized Trial. Abstract 407-08, ACC 2021 Scientific Session, 15-17 May 2021

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Article image: mr.suphachai praserdumrongchai

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