Multivessel Angioplasty Recommended Following Heart Attack

A new study suggests that performing revascularization of both infarct-related and non-related arteries following myocardial infarction (MI) results in a lower overall risk than treating the infarct-related artery alone.

Researchers at Maasstad Ziekenhuis, the University of Gothenburg, and other institutions randomly assigned 885 primary percutaneous coronary intervention (PCI) patients to undergo revascularization of the infarct-related artery alone, or complete revascularization of all non–infarct-related coronary arteries as guided by fractional flow reserve (FFR). The primary end point was a composite of death from any cause, nonfatal MI, revascularization, and cerebrovascular events at 12 months.

The results showed that the primary composite endpoint occurred in 20.5% of patients receiving infarct-only revascularization, compared to only 7.8% in those receiving FFR-guided complete revascularization. There was no significant difference in the rates of all-cause mortality, non-fatal heart attack, or stroke; however, there was a significant reduction in the incidence of subsequent revascularization procedures among patients randomized to receive complete revascularization.

The researchers also found that while performing complete revascularization increases the complexity of the PCI, overall surgery times were on average just six minutes longer than the procedures in the infarct-only revascularization arm. Furthermore, FFR-guided complete revascularization allowed the surgeons to fine-tune treatment, with better outcome results. The study was presented at the American College of Cardiology (ACC) 66th annual scientific session, held during March 2017 in Washington (DC, USA).

“Our study shows you can optimize treatment with this approach and potentially also have economic benefits by reducing the need for extra procedures,” said lead author and study presenter cardiologist Pieter Smits, MD, of Maasstad Ziekenhuis. “It’s a tremendous advantage to know that you have been treated for the artery that brought you to the hospital, but also that any other issues have already been investigated and treated if needed. This way the patient won’t need to be brought back to the hospital later on and again be put at risk with an invasive procedure or additional diagnostics.”

FFR is a physiological index used to determine the hemodynamic severity of atherosclerotic narrowing of the coronary arteries. It specifically identifies which coronary narrowing is responsible for the ischemic obstruction of the flow of blood to the heart muscle, and helps guide the interventional cardiologist in determining which lesions warrant stenting, resulting in improved patient outcomes and reduced health care costs.