Fractional Flow Reserve in Acute Myocardial Infarction: A Guide for Non-Culprit Lesions?
نویسندگان
چکیده
In patients presenting with ST-segment elevation myocardial infarction (STEMI) and multi-vessel disease (MVD), the optimal therapy for non-culprit lesions is still a matter of debate. While guidelines discourage a concomitant treatment of infarct- and non-infarct-related arteries, recent studies document advantages of a complete (preventive) revascularization during primary percutaneous coronary intervention. Such an approach, however, may result in overtreatment, because angiography does not provide robust information about the functional severity of MVD. Fractional flow reserve (FFR) measurements can be a valuable guide for non-culprit lesions in acute myocardial infarction, but so far, only the reliability and safety of FFR measurements have been established in this setting. The clinical implications of an FFR-guided treatment strategy in STEMI patients with MVD are currently being tested in a large randomized trial.
منابع مشابه
Fractional flow reserve in acute coronary syndromes: A review
Fractional flow reserve (FFR) assessment provides anatomical and physiological information that is often used to tailor treatment strategies in coronary artery disease. Whilst robust data validates FFR use in stable ischaemic heart disease, its use in acute coronary syndromes (ACS) is less well investigated. We critically review the current data surrounding FFR use across the spectrum of ACS in...
متن کاملFractional flow reserve of non-culprit vessel post-myocardial infarction: is it reliable?
BACKGROUND Multi-vessel disease is frequent in patients presenting with myocardial infarction and have an important prognostic impact. The decision to proceed to revascularization in non-culprit vessels can be postponed until ischemia is proven in non-invasive stress tests. On the other hand, there is an increasing evidence to support the role of fractional flow reserve (FFR) in acute coronary ...
متن کاملLetter by Layland et al regarding article, "Validation of intravascular ultrasound-derived parameters with fractional flow reserve for assessment of coronary stenosis severity".
To the Editor: We read with great interest the study by Kang et al 1 that explored the relationship between intravascular ultrasound parameters and fractional flow reserve (FFR) in the assessment of intermediate coronary stenoses. 1 We congratulate the authors, who concluded that lesions with a mean luminal area of Ͻ2.4 mm 2 had a high sensitivity and negative predictive value to predict FFR Ͻ0...
متن کاملVasodilatory capacity of the coronary microcirculation is preserved in selected patients with non-ST-segment-elevation myocardial infarction.
BACKGROUND The use of fractional flow reserve in patients with non-ST-segment-elevation myocardial infarction (NSTEMI) is a controversial issue. We undertook a study to assess the vasodilatory capacity of the coronary microcirculation in patients with NSTEMI when compared with a model of preserved microcirculation (stable angina [SA] cohort: culprit and nonculprit vessel) and acute microcircula...
متن کاملManagement of Multivessel Coronary Disease in ST-segment Elevation Myocardial Infarction
Primary PCI of infarct-related arteries is the preferred reperfusion strategy in patients presenting with ST-segment elevation myocardial infarction (STEMI). Up to 40 % of such patients demonstrate evidence of multivessel, non-infarct-related artery coronary disease. Previous non-randomised observational studies and their associated meta-analyses have suggested that in such cases only the culpr...
متن کامل