CBS - The 17th Left Main & Coronary Bifurcation Summit, CBS2025

科学研究

Comparison of intravascular ultrasound-guided with angiography-guided double kissing crush stenting for patients with complex coronary bifurcation lesions: rationale and design of a prospective, randomized and multicenter DKCRUSH VIII trial Optimal Fluoroscopic Projections of Coronary Ostia and Bifurcations Defined by Computed Tomographic Coronary Angiography ‘Small bifurcation?’ CT myocardial mass volume measurements change therapeutic strategy in coronary artery disease Prognostic Implications of Plaque Characteristics and Stenosis Severity in Patients With Coronary Artery Disease Optical coherence tomography-guided percutaneous coronary intervention in ST-segmentelevation myocardial infarction: a prospective propensity-matched cohort of the thrombectomy versus percutaneous coronary intervention alone trial Optical Coherence Tomography to Optimize Results of Percutaneous Coronary Intervention in Patients with Non-ST-Elevation Acute Coronary Syndrome: Results of the Multicenter, Randomized DOCTORS Study (Does Optical Coherence Tomography Optimize Results of Stenting) Classification and treatment of coronary artery bifurcation lesions: putting the Medina classification to the test T and small protrusion (TAP) vs double kissing crush technique: Insights from in-vitro models Coronary CT Angiographic and Flow Reserve-Guided Management of Patients With Stable Ischemic Heart Disease One Versus 2-stent Strategy for the Treatment of Bifurcation Lesions in the Context of a Coronary Chronic Total Occlusion: A Multicenter Registry

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Clinical Trial2019 Apr 22;12(8):721-730.

JOURNAL：JACC Cardiovasc Interv. Article Link

Complete Revascularization Versus Culprit Lesion Only in Patients With ST-Segment Elevation Myocardial Infarction and Multivessel Disease: A DANAMI-3-PRIMULTI Cardiac Magnetic Resonance Substudy

Kyhl K, Ahtarovski KA, Nepper-Christensen L et al. Keywords: ST-segment elevation myocardial infarction; acute myocardial infarction; cardiac function; cardiac remodeling; cardiovascular magnetic resonance; complete revascularization; culprit lesion; primary percutaneous coronary intervention; randomization; randomized study

ABSTRACT

OBJECTIVES - The aim of this study was to evaluate the effect of fractional flow reserve (FFR)-guided revascularization compared with culprit-only percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI) on infarct size, left ventricular (LV), function, LV remodeling, and the presence of nonculprit infarctions.

BACKGROUND - Patients with STEMI with multivessel disease might have improved clinical outcomes after complete revascularization compared with PCI of the infarct-related artery only, but the impact on infarct size, LV function, and remodeling as well as the risk for periprocedural infarction are unknown.

METHODS - In this substudy of the DANAMI-3 (Third Danish Trial in Acute Myocardial Infarction)-PRIMULTI (Primary PCI in Patients With ST-Elevation Myocardial Infarction and Multivessel Disease: Treatment of Culprit Lesion Only or Complete Revascularization) randomized trial, patients with STEMI with multivessel disease were randomized to receive either complete FFR-guided revascularization or PCI of the culprit vessel only. The patients underwent cardiac magnetic resonance imaging during index admission and at 3-month follow-up.

RESULTS - A total of 280 patients (136 patients with infarct-related and 144 with complete FFR-guided revascularization) were included. There were no differences in final infarct size (median 12% [interquartile range: 5% to 19%] vs. 11% [interquartile range: 4% to 18%]; p = 0.62), myocardial salvage index (median 0.71 [interquartile range: 0.54 to 0.89] vs. 0.66 [interquartile range: 0.55 to 0.87]; p = 0.49), LV ejection fraction (mean 58 ± 9% vs. 59 ± 9%; p = 0.39), and LV end-systolic volume remodeling (mean 7 ± 22 ml vs. 7 ± 19 ml; p = 0.63). New nonculprit infarction occurring after the nonculprit intervention was numerically more frequent among patients treated with complete revascularization (6 [4.5%] vs. 1 [0.8%]; p = 0.12).

CONCLUSIONS - Complete FFR-guided revascularization in patients with STEMI and multivessel disease did not affect final infarct size, LV function, or remodeling compared with culprit-only PCI.

科研文章

荐读文献

Complete Revascularization Versus Culprit Lesion Only in Patients With ST-Segment Elevation Myocardial Infarction and Multivessel Disease: A DANAMI-3-PRIMULTI Cardiac Magnetic Resonance Substudy

ABSTRACT