Coronary interventions - Mini focus: Physiology indices

Fractional flow reserve-guided PCI in patients with and without left ventricular hypertrophy: a DANAMI-3-PRIMULTI substudy

EuroIntervention 2020;16:584-590. DOI: 10.4244/EIJ-D-19-00577

Muhammad Sabbah
Muhammad Sabbah1, MD; Lars Nepper-Christensen1, MD, PhD; Jacob Lønborg1, MD, PhD, DMSc; Steffen Helqvist1, MD, DMSc; Lars Køber1, MD, DMSc; Dan Eik Høfsten1, MD, PhD; Kiril Aleksov Ahtarovski1, MD, PhD; Christoffer Göransson1, MD; Kasper Kyhl1, MD, PhD; Mikkel Malby Schoos1, MD, PhD; Niels Vejlstrup1, MD, PhD; Henning Kelbæk2, MD, DMSc; Thomas Engstrøm1, MD, PhD, DMSc
1. Department of Cardiology, Rigshospitalet - Copenhagen University Hospital, Copenhagen, Denmark; 2. Department of Cardiology, Zealand University Hospital, Roskilde, Denmark

Aims: The aim of this substudy was 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 revascularisation versus culprit only, in terms of risk of clinical outcome.

Methods and results: In this DANAMI-3-PRIMULTI substudy, 279 patients with STEMI had cardiac magnetic resonance (CMR) imaging 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 two-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 (Spearman’s ρ=–0.40 and –0.41 without LVH and with LVH, respectively; p<0.001) but were not different between patients without and with LVH (p for interaction=0.87). FFR-guided complete revascularisation was associated with reduced risk of death, myocardial infarction or ischaemia-driven revascularisation both for patients without LVH (HR 0.42, 95% CI: 0.20-0.85) and for patients with LVH (HR 0.50, 95% CI: 0.17-1.47), with no interaction between the FFR-guided complete revascularisation 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 revascularisation on the occurrence of subsequent clinical events.

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fractional flow reservemultiple vessel diseasestemi
Coronary interventionsSTEMILeft main and multivessel diseaseOther coronary interventions
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