- Question
- In patients with ST-elevation myocardial infarction and multivessel disease, does fractional flow reserve (FFR)-guided complete revascularization of non-infarct-related arteries in the acute setting improve outcomes compared with treating only the infarct-related artery?
- Design
- Randomized trial, unmasked according to the registry, of 885 patients assigned 1:2. FFR was measured in both groups, but in the control group neither the patient nor their cardiologist knew the results. Follow-up was 12 months.
- Population
- Patients with ST-elevation myocardial infarction and multivessel coronary disease who had undergone primary PCI of the infarct-related artery.
- Intervention
- FFR-guided complete revascularization of non-infarct-related arteries (295 patients) during the same procedure; the registry defines lesions to be treated as those with FFR ≤0.80.
- Control
- No revascularization of non-infarct-related arteries (590 patients): the procedure ended after FFR measurement and the treating cardiologist, blinded to those values, decided subsequent management. Clinically indicated elective revascularizations within 45 days were not counted as events in this group.
- Primary outcome
- Composite of all-cause death, nonfatal myocardial infarction, revascularization, and cerebrovascular events at 12 months.
- Results
- The primary outcome occurred in 23 patients in the complete-revascularization group and in 121 in the infarct-artery-only group (8 vs. 21 events per 100 patients; HR 0.35; 95% CI, 0.22 to 0.55; P<0.001). The difference was driven mainly by fewer subsequent revascularizations (6.1% vs. 17.5%; HR 0.32; 95% CI, 0.20 to 0.54).
- Safety
- An FFR-related serious adverse event occurred in 2 patients, both in the infarct-artery-only group.
- Conclusion
- FFR-guided complete revascularization in the acute setting lowered the risk of the composite cardiovascular outcome compared with treating the infarct-related artery only, mainly through fewer subsequent revascularizations.
- Why it matters
- It provided evidence supporting physiological assessment and treatment of non-infarct-related lesions during primary PCI, in an area that had previously been controversial.
Card generated automatically with AI from the abstract of the original publication and the trial registry; every figure was checked against those sources. It may contain errors: verify the data at the source before using it for clinical decisions.
Generated on October 14, 2026