Fractional Flow Reserve-guided Complete versus Culprit-Only Revascularization in ST-elevation Myocardial Infarction patients with Multivessel Disease: A Meta-Analysis

Jingxian Yang ^1,2 Peng Wang ² Jun Wan ¹ Na Li ¹ Jiajia Didi ² Binger Shen ² Xinyu Yang ² Feina Li ¹ Yu Zhang ^1*

• ¹ Affiliated Hospital of Chengdu University, Center for Evidence-based Medicine, Chengdu, China
• ² Affiliated Hospital of Chengdu University, Department of critical care medicine, Chengdu, China

BACKGROUND: Among patients with ST-elevation myocardial infarction (STEMI) and multivessel disease, whether fractional flow reserve (FFR) guided complete revascularization (CR) is superior to the now widely used culprit-only (COR) revascularization is unclear.We conducted a search of PubMed, Embase, the Cochrane Library, and CNKI for randomized controlled trials comparing FFR-guided CR with COR in STEMI patients with multivessel disease. Data extraction and analysis adhered to Cochrane guidelines, with major adverse cardiac events as the primary outcome.This meta-analysis included 6 trials involving 3,482 patients. FFR-guided CR was associated with a reduction in major adverse cardiac events (RR: 0.66, 95% CI: 0.46-0.94, 95% PI: 0.20-2.19), ischemia-driven revascularization (RR: 0.27, 95% CI: 0.19-0.40, 95% PI: 0.16-0.46), and repeat percutaneous coronary interventions (RR: 0.35, 95% CI: 0.22-0.50, 95% PI: 0.16-0.78) compared to COR. However, no difference was observed in all-cause mortality (RR: 1.12, 95% CI: 0.86-1.46, 95% PI: 0.79-1.58) or safety outcomes.CONCLUSION: FFR-guided CR reduces major adverse cardiac events compared to COR, though benefits may vary across settings. It significantly lowers ischemia-driven revascularization and repeat percutaneous coronary interventions, with no difference in all-cause mortality compared to COR.