한빛사 논문
Joo Myung Lee1†, Hyun Kuk Kim2†, Keun Ho Park2, Eun Ho Choo3, Chan Joon Kim4, Seung Hun Lee5, Min Chul Kim5, Young Joon Hong5, Sung Gyun Ahn6, Joon-Hyung Doh7, Sang Yeub Lee8,9, Sang Don Park10, Hyun-Jong Lee11, Min Gyu Kang12, Jin-Sin Koh12, Yun-Kyeong Cho13, Chang-Wook Nam13, Bon-Kwon Koo14, Bong-Ki Lee15, Kyeong Ho Yun16, David Hong1, Hyun Sung Joh1, Ki Hong Choi1, Taek Kyu Park1, Jeong Hoon Yang1, Young Bin Song1, Seung-Hyuk Choi1, Hyeon-Cheol Gwon1, and Joo-Yong Hahn 1*, The FRAME-AMI Investigators‡
1Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81, Irwon-ro, Gangnam-gu, Seoul 06351, Korea;
2Chosun University Hospital, University of Chosun College of Medicine, 365 Pilmun-daero, Dong-gu, Gwangju 61453, Korea;
3Seoul St. Mary’s Hospital, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 06591, Korea;
4Uijeongbu St. Mary’s Hospital, The Catholic University of Korea, 271 Cheonbo-ro, Uijeongbu, Gyeonggi-do 11765, Korea;
5Department of Internal Medicine, Chonnam National University Hospital, 42 Jebong-ro, Dong-gu, Gwangju 61469, Korea;
6Department of Internal Medicine, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, 20 Ilsan-ro, Wonju, Gangwon-do 26426, Korea;
7Department of Internal Medicine, Inje University Ilsan Paik Hospital, 170 Juhwa-ro, Ilsanseo-gu, Goyang, Gyeonggi-do 10380, Korea;
8Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, 776 Sunhawn-ro, Cheongju, Chungcheongbuk-do 28644, Korea;
9Department of Internal Medicine, Chung-Ang University Gwangmyeong Hospital, Chung-Ang University College of Medicine, 501 Iljik-dong, Gwangmyeong, Gyeonggi-do 14353,
Korea;
10Inha University Hospital, 27 Inhang-ro, Jung-gu, Incheon 22332, Korea;
11Department of Internal Medicine, Sejong General Hospital, 20 Gyeyangmunhwa-ro, Gyeyang-gu, Incheon 21080, Korea;
12Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, 501 Jinju-daero, Jinju, Gyeongsangnam-do
52727, Korea;
13Keimyung University Dongsan Medical Center, 1035 Dalgubeol-daero, Dalseo-gu, Daegu 42601, Korea;
14Department of Internal Medicine, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul 03080, Korea;
15Department of Internal Medicine, Kangwon National University Hospital, Kangwon National University School of Medicine,
Baengnyeong-ro 156, Chuncheon, Gangwon-do 24289, Korea;
16Department of Internal Medicine, Wonkwang University Hospital, 895 Muwang-ro, Iksan, Jeollabuk-do 54538, Korea
* Corresponding author: Joo-Yong Hahn
† Drs. JM Lee and HK Kim equally contributed as first authors
Abstract
Aims: In patients with acute myocardial infarction (MI) and multivessel coronary artery disease, percutaneous coronary intervention (PCI) of non-infarct-related artery reduces death or MI. However, whether selective PCI guided by fractional flow reserve (FFR) is superior to routine PCI guided by angiography alone is unclear. The current trial sought to compare FFR-guided PCI with angiography-guided PCI for non-infarct-related artery lesions among patients with acute MI and multivessel disease.
Methods and results: Patients with acute MI and multivessel coronary artery disease who had undergone successful PCI of the infarct-related artery were randomly assigned to either FFR-guided PCI (FFR ≤0.80) or angiography-guided PCI (diameter stenosis of >50%) for non-infarct-related artery lesions. The primary end point was a composite of time to death, MI, or repeat revascularization. A total of 562 patients underwent randomization. Among them, 60.0% underwent immediate PCI for non-infarct-related artery lesions and 40.0% were treated by a staged procedure during the same hospitalization. PCI was performed for non-infarct-related artery in 64.1% in the FFR-guided PCI group and 97.1% in the angiography-guided PCI group, and resulted in significantly fewer stent used in the FFR-guided PCI group (2.2 ± 1.1 vs. 2.5 ± 0.9, P < 0.001). At a median follow-up of 3.5 years (interquartile range: 2.7-4.1 years), the primary end point occurred in 18 patients of 284 patients in the FFR-guided PCI group and in 40 of 278 patients in the angiography-guided PCI group (7.4% vs. 19.7%; hazard ratio, 0.43; 95% confidence interval, 0.25-0.75; P = 0.003). The death occurred in five patients (2.1%) in the FFR-guided PCI group and in 16 patients (8.5%) in the angiography-guided PCI group; MI in seven (2.5%) and 21 (8.9%), respectively; and unplanned revascularization in 10 (4.3%) and 16 (9.0%), respectively.
Conclusion: In patients with acute MI and multivessel coronary artery disease, a strategy of selective PCI using FFR-guided decision-making was superior to a strategy of routine PCI based on angiographic diameter stenosis for treatment of non-infarct-related artery lesions regarding the risk of death, MI, or repeat revascularization.
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