The Official Journal of EuroPCR and the European Association of Percutaneous Coronary Interventions (EAPCI)

Fractional Flow Reserve Guided PCI in Patients With and Without Left Ventricular Hypertrophy: a DANAMI-3-PRIMULTI Sub-study

DOI: 10.4244/EIJ-D-19-00577

1. Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark, Denmark
2. Rigshospitalet – Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
3. Rigshospitalet – Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
4. Rigshospitalet – Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
5. Rigshospitalet – Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
6. Rigshospitalet – Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
7. Rigshospitalet – Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
8. Rigshospitalet – Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
9. Rigshospitalet – Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
10. Rigshospitalet – Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
11. Rigshospitalet – Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
12. Zealand University Hospital, Department of Cardiology, Roskilde, Denmark
13. Rigshospitalet – Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
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Aims: To investigate the correlation between fractional flow reserve (FFR) and diameter stenosis in patients with STEMI with and without left ventricular hypertrophy (LVH), and the influence of LVH on complete FFR-guided revascularization versus culprit only, in terms of risk of clinical outcome. 

Methods and results: In this DANAMI-3-PRIMULTI sub-study, 279 patients with STEMI had cardiac magnetic resonance (CMR) for assessment of left-ventricular-mass-index. Ninety-six patients had FFR evaluation of a non-culprit lesion. Diameter stenosis of the non-culprit lesion was determined with 2-dimensional quantitative-coronary-analysis. The diameter stenosis (56.9% vs. 54.3%, p=0.38) and FFR value (0.83 vs. 0.85, p=0.34) were significantly correlated in both groups (Spearmans ρ=-0.40 and -0.41 without LVH and with LVH, respectively; p<0.001) but was not different between patients without and with LVH (p for interaction =0.87). FFR-guided complete revascularization was associated with reduced risk of death, myocardial infarction or ischemia-driven revascularization for both patients without LVH (HR 0.42, 95%CI 0.20-0.85) and for patients with LVH (HR 0.50, 95%CI 0.17-0.47), with no interaction between the FFR-guided complete revascularization and LVH (p for interaction =0.82). 

Conclusions: LVH did not interact with the correlation between diameter stenosis and FFR and did not modify the impact of complete revascularization on the occurrence of subsequent clinical events.

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