FULL REVASC
Trial question
What is the role of FFR-guided complete revascularization in patients with STEMI or very-high-risk NSTEMI and multivessel coronary artery disease?
Study design
Multi-center
Open label
RCT
Population
Characteristics of study participants
24.0% female
76.0% male
N = 1542
1542 patients (365 female, 1177 male).
Inclusion criteria: patients with STEMI or very-high-risk NSTEMI and multivessel coronary artery disease.
Key exclusion criteria: previous CABG; left main coronary artery disease; cardiogenic shock.
Interventions
N=764 complete revascularization (FFR-guided complete revascularization of nonculprit lesions).
N=778 culprit lesion-only PCI (no further revascularization during index hospitalization after undergoing primary PCI of the culprit lesion).
Primary outcome
Death from any cause, MI, or unplanned revascularization
19%
20.4%
20.4 %
15.3 %
10.2 %
5.1 %
0.0 %
Complete
revascularization
Culprit lesion-only
PCI
No significant
difference ↔
No significant difference in death from any cause, MI, or unplanned revascularization (19% vs. 20.4%; HR 0.93, 95% CI 0.74 to 1.17).
Secondary outcomes
No significant difference in death from any cause or MI (16.5% vs. 15.3%; HR 1.12, 95% CI 0.87 to 1.44).
No significant difference in unplanned revascularization (9.2% vs. 11.7%; HR 0.76, 95% CI 0.56 to 1.04).
No significant difference in death from any cause (9.9% vs. 9.3%; HR 1.15, 95% CI 0.83 to 1.58).
Safety outcomes
No significant differences in contrast-associated AKI, neurologic complications during the index hospitalization.
Conclusion
In patients with STEMI or very-high-risk NSTEMI and multivessel coronary artery disease, complete revascularization was not superior to culprit lesion-only PCI with respect to death from any cause, MI, or unplanned revascularization.
Reference
Felix Böhm, Brynjölfur Mogensen, Thomas Engstrøm et al. FFR-Guided Complete or Culprit-Only PCI in Patients with Myocardial Infarction. N Engl J Med. 2024 Apr 25;390(16):1481-1492.
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