Abstract 1996: Non-culprit Lesions Detected During Primary PCI: Treat Invasively Or Follow The Guidelines?
Background. Evidence regarding the optimal treatment of non-culprit lesions detected during primary PCI is lacking. A conservative approach is advocated by the current guidelines. However, a more aggressive approach may prevent recurrent cardiac events and improve left ventricular function.
Methods. Of 120 patients with at least 1 non-culprit lesion, 80 were randomized to early follow-up coronary angiography including Fractional Flow Reserve (FFR)-guided PCI (invasive group), and 40 to medical treatment followed by ischemia detection at a later stage (conservative group). Primary endpoint was left ventricular ejection fraction at 6 months.
Results. The number of non-culprit lesions per patient was identical in both groups (1.25 ± 0.44 vs 1.25 ± 0.44, p=1.00). In the invasive group, follow-up angiography was performed 13 ± 13 days after primary PCI. Only 60 % of the non-culprit lesions that were considered significant during primary PCI had a FFR < 0.75 at follow up indicating hemodynamic significance. Subsequent PCI of at least 1 non-culprit lesion guided by FFR was performed in 50% of patients, PCI without preceding FFR was performed in 15% and CABG was done in 5%. After 236 ± 152 days of follow up, PCI of non-culprit lesions was more frequently needed in the conservative group (18% vs 4%, p=0.015) but the incidence of recurrent myocardial infarction was higher in the invasive group (10% vs 0%, p=0.051), half of which were non-culprit lesion related (5% vs 0%, p=0.150). Death and total major adverse cardiac events were not different between groups.
Conclusion: The hemodynamic significance of non-culprit lesions detected during primary PCI is frequently overestimated (40%). Early PCI of non-culprit lesions guided by FFR prevents later PCI procedures but does not result in a reduction of total major cardiac events compared to a more conservative strategy. Data on the primary endpoint at 6 months (EF) will be presented.