Multivessel PCI Guided by FFR or Angiography for Myocardial Infarction

This randomized multicenter trial (FLOWER-MI) compared fractional flow reserve (FFR)-guided versus angiography-guided complete revascularization in patients with ST-elevation myocardial infarction (STEMI) and multivessel coronary disease following successful infarct-related PCI. A total of 1171 patients were assigned to receive nonculprit lesion intervention guided by either FFR or angiography. At 1 year, the composite outcome of death, nonfatal myocardial infarction, or urgent revascularization occurred in 5.5% of the FFR group and 4.2% of the angiography group (HR 1.32; 95% CI, 0.78–2.23; P=0.31), with no significant difference. FFR guidance resulted in fewer stents per patient (mean 1.01 vs. 1.50) and reduced PCI rates (66.2% vs. 97.1%) but did not improve clinical outcomes. Most interventions were staged rather than immediate. The authors note that the wide confidence intervals limit firm conclusions and suggest further research to clarify FFR’s role in multivessel STEMI.

This randomized multicenter trial (FLOWER-MI) compared fractional flow reserve (FFR)-guided versus angiography-guided complete revascularization in patients with ST-elevation myocardial infarction (STEMI) and multivessel coronary disease following successful infarct-related PCI. A total of 1171 patients were assigned to receive nonculprit lesion intervention guided by either FFR or angiography. At 1 year, the composite outcome of death, nonfatal myocardial infarction, or urgent revascularization occurred in 5.5% of the FFR group and 4.2% of the angiography group (HR 1.32; 95% CI, 0.78–2.23; P=0.31), with no significant difference. FFR guidance resulted in fewer stents per patient (mean 1.01 vs. 1.50) and reduced PCI rates (66.2% vs. 97.1%) but did not improve clinical outcomes. Most interventions were staged rather than immediate. The authors note that the wide confidence intervals limit firm conclusions and suggest further research to clarify FFR’s role in multivessel STEMI.