P066 - FRACTIONAL FLOW RESERVE-GUIDED COMPLETE VERSUS CULPRIT-ONLY REVASCULARIZATION IN PATIENTS WITH MYOCARDIAL INFARCTION AND MULTIVESSEL DISEASE: A SYSTEMATIC REVIEW AND META-ANALYSIS

Background:

Background: In patients with myocardial infarction (MI) and multivessel coronary artery disease (CAD), the impact of fractional flow-reserve (FFR)-guided complete revascularization during index hospitalization versus culprit-only revascularization remains unclear. Our objectives to determine whether FFR-guided complete revascularization during index hospitalization reduces major adverse cardiac events (MACE) among patients with MI and multivessel CAD compared to culprit-only revascularization.

METHODS AND RESULTS: We systematically searched MEDLINE, EMBASE, and the Cochrane Library for randomized controlled trials (RCTs) comparing FFR-guided complete versus culprit-only revascularization in patients with MI and multivessel CAD. The primary outcome was MACE, as defined by a composite endpoint of all-cause death, MI or unplanned revascularization, at a minimum one-year follow-up. Count data were pooled across trials using random-effects models with inverse variance weighting to estimate risk ratios (RRs) and 95% confidence intervals (CIs). A total of three RCTs (n=3,054) were included. The majority (77.5%) of participants were male. The pooled RR of MACE for FFR-guide complete versus culprit-only revascularization was 0.63 (95% CI: 0.37-1.05; I2 = 90%). FFR-guided complete revascularization was associated with reduced unplanned revascularization events, with a pooled RR of 0.43 (95% CI: 0.21-0.87; I2 = 88%). There was no significant difference in the risk of recurrent MI (RR: 0.9; 95% CI: 0.61-1.33; I2 =30%). The risk of major bleeding was low in the both FFR-guided complete (1.68%) and culprit-only (1.73%) revascularization groups across the three trials.

Conclusion: In patients with MI and multivessel CAD, FFR-guided complete revascularization during the index hospitalization reduces the risk of unplanned revascularizations and may reduce the risk of MACE compared to culprit-only revascularization.