Heart X-ray tops FFR-guided stent placement in patients who’ve suffered a severe heart attack

Using a common technique that measures blood flow and pressure through obstructed arteries to determine if patients require a coronary stent carries more downside compared to a common imaging exam, researchers reported recently.

Fractional flow reserve helps physicians assess the severity of narrowing within the artery and helps guide stent placement to restore blood flow to the heart. Typically performed in those who’ve suffered a heart attack, some research has shown FFR-guided stenting yields better outcomes in certain situations.

In patients who endured a severe type of heart attack, however, FFR-guided stenting did not improve health outcomes and proved more expensive than angiography (heart X-ray) alone to inform stent placement, authors explained over the weekend at the American College of Cardiology’s virtual annual meeting

"The strategy of using fractional flow reserve to guide the stenting procedure is not superior to the standard technique of using angiography to treat additional partially blocked arteries," Etienne Puymirat, MD, professor of cardiology at the University of Paris and director of intensive care at the Georges Pompidou Hospital in Paris, said May 16. "In addition to having no benefit, we have also shown that, based on costs in France, the FFR-guided strategy is more expensive."

A majority of heart attacks are caused by a blood clot in a key artery that’s been restricted by fatty buildup or plaque. And in STEMI heart attacks, this artery is totally blocked off.

The FLOWER-MI trial compared outcomes in STEMI patients to those with multi-vessel disease who underwent either FFR-guided stenting or angiography alone to direct the procedure.

The investigation included 1,171 patients with a stent inserted after their heart attack and who also had another coronary artery that was at least 50% obstructed.

After 1-year follow-up across 41 health centers in France, 5.5% of participants in the FFR group died, had a second non-fatal heart attack, or underwent another stent procedure. By comparison, 4.2% in the angiography group showed the same outcomes, a non-statistical difference, the authors explained.

Puymirat and colleagues did note their study failed to meet its primary endpoint but they plan to follow the participants for two more years to glean further results.

You can read the full study published May 16 in the New England Journal of Medicine.

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