Abstract Body (Do not enter title and authors here): Background: Fractional flow reserve (FFR) or angiography-guided complete revascularization was not evaluated in patients with acute myocardial infarction (MI) with reduced left ventricular ejection fraction (LVEF).
Objectives: To evaluate impact of FFR-guided percutaneous coronary intervention (PCI) for AMI patients with multivessel disease according to left ventricular systolic function.
Methods: We performed pre-specified analysis of FRAME-AMI trial which randomly allocated 562 patients into either FFR-guided PCI (FFR≤0.80) or angiography-guided PCI (diameter stenosis of >50%) for non-infarct related artery (IRA). Patients were classified by LVEF into the preserved (LVEF ≥50%) and reduced (LVEF <50%) groups. The primary end point was patient-oriented composite outcome (POCO), a composite of death, MI, and repeat revascularization.
Results: Overall, 187 patients (33.3%) had reduced LVEF. At 4-year follow-up, AMI patients with reduced LVEF showed increased risk of MACE than those with preserved LVEF (18.9% vs. 10.8%; adjusted HR=2.65, 95% CI 1.53-4.58, P<0.001). FFR-guided PCI for non-IRA significantly reduced POCO among preserved LVEF group (3.3% vs. 19.0%; adjusted HR=0.23, 95% CI 0.09-0.59, P=0.002). Conversely, there was no significant difference in POCO between FFR and angiography-guided PCI among reduced LVEF group (17.0% vs. 21.0%; HR=0.64, 95% CI 0.31-1.32, P=0.227). The prognostic impact of FFR-guided PCI tended to increase as LVEF increased (adjusted HR for POCO: 0.69 vs. 0.66 vs. 0.25 vs. 0.20, respectively, for the LVEF ≤40% vs. 40-50% vs. 50-60% vs. ≥60%, interaction P=0.028).
Conclusion: In acute MI patients with multivessel disease, FFR-guided PCI for non-IRA showed differential clinical impact according to left ventricular systolic function. The beneficial effect of FFR-guided PCI might be maximized among patients with preserved LVEF rather than reduced LVEF.