Читать книгу Interventional Cardiology - Группа авторов - Страница 187

FFR has been used in patients with acute coronary syndromes with reasonable reproducibility, despite concerns that the microvasculature is not optimally responsive to adenosine shortly after infarction. In STEMI, it should not be used in the culprit artery due to the impact of thrombus embolization, stunning of the myocardium and microvascular dysfunction. Non‐culprit vessels have been assessed with FFR in patients with STEMI. This has been performed during the index procedure for STEMI in the COMPARE‐ACUTE study [54], and after an interval within the same inpatient stay in the DANAMI3‐PRIMULTI study [55]. Both have shown utility in reducing later revascularization although there was no difference in major events. Meta‐analysis of studies considering multi‐vessel non‐culprit intervention vs culprit‐only intervention, have shown a benefit for revascularizing non‐culprit lesions. The benefit is seen by a reduction in re‐infarction rates, repeat revascularization, and cardiovascular mortality [56]. Assessing non‐culprit vessels remains an area of significant interest with many different modalities available [57].

In NSTEMIs, FFR has been used in non‐culprit lesions and these patients have been included in the original FAME study. However, in some cases the culprit lesions can be more challenging to identify. In the FAMOUS‐NSTEMI study, FFR was used to guide revascularization decisions in all vessels, which will have included the culprit vessel [58]. Although the study was underpowered to derive clinical outcomes and the primary outcome measure was not clinically meaningful, the event rate in patients deferred for PCI appeared to be high.