2021Acute coronary syndromesIntervention

FLOWER-MI

Therapy group: Complete revascularization · Therapy: FFR-guided vs angiography-guided complete revascularization in STEMI

In multivessel STEMI, FFR-guided complete revascularization showed no advantage over angiography guidance for death, MI or urgent revascularization at one year.

Published in N Engl J Med (2021)

Question: In patients with STEMI and multivessel disease, is complete revascularization guided by fractional flow reserve (FFR) superior to angiography-guided revascularization?
Design: Multicenter, randomized, open-label (no masking) trial comparing two complete revascularization strategies. The primary follow-up was 1 year.
Population: Patients with ST-elevation myocardial infarction and multivessel disease who had undergone successful PCI of the infarct-related artery.
Intervention: PCI of nonculprit lesions guided by FFR measurement.
Control: PCI of nonculprit lesions guided by angiography.
Primary outcome: Composite of death from any cause, nonfatal myocardial infarction, or unplanned hospitalization leading to urgent revascularization at 1 year.
Results: A primary outcome event occurred in 32 of 586 patients (5.5%) in the FFR-guided group and in 24 of 577 (4.2%) in the angiography-guided group (HR 1.32; 95% CI 0.78 to 2.23; P = 0.31). Mean stents per patient for nonculprit lesions were 1.01±0.99 with FFR and 1.50±0.86 with angiography.
Conclusion: The FFR-guided strategy showed no significant benefit over the angiography-guided strategy, although the wide confidence intervals preclude a conclusive interpretation.
Why it matters: It questioned the need for routine FFR to decide on treatment of nonculprit lesions in STEMI, while leaving open the question owing to the imprecision of the estimate.

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 18, 2026

Sources

Original publication on PubMed (PMID 33999545) ↗Multivessel PCI Guided by FFR or Angiography for Myocardial Infarction.
Journal article (DOI) ↗
ClinicalTrials.gov record (NCT02943954) ↗

Videos explaining it

The SEC takes you to ACC21 [IN] ∙ FLOWER-MI Trial

SEC · Sociedad Española de Cardiología ↗4:47Video page

Source: Sociedad Española de Cardiología · YouTube
Date: 16 May 2021
Audio: Spanish
Subtitles: MultilingualYouTube
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