Using a network meta-analysis, this study compared fractional flow reserve (FFR) guided with angiography-guided revascularization of non-culprit lesions in ST elevation myocardial infarction (STEMI). We also assessed if early complete revascularization is superior to delayed revascularization. We conducted a network meta-analysis using Net Meta XL of trials of STEMI patients with multivessel disease and compared revascularization strategies. The primary outcomes of interest were rate of revascularization, myocardial infarction, and all-cause mortality. Ten studies were included in our analysis comprising 7981 patients with 4484 patients undergoing complete revascularization and 3497 patients with culprit-only revascularization. There was no significant reduction in all-cause death, myocardial infarction, or revascularization using FFR guidance. There was significant reduction in repeat revascularization with complete revascularization irrespective of timing of percutaneous coronary intervention (PCI) compared with the culprit-only group. There was an overall trend favoring earlier revascularization. For patients with multivessel disease presenting with ST-elevation MI, complete revascularization significantly reduces repeat revascularization compared with culprit-only treatment. FFR guidance is non-superior to angiography-guided revascularization. Furthermore, there was significant reduction in repeat revascularization irrespective of timing of PCI to non-culprit vessels.

中文翻译：

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血流储备分数和血管造影引导初次经皮冠状动脉介入治疗中完全血运重建：系统评价和网络荟萃分析

本研究使用网络荟萃分析，比较了 ST 段抬高型心肌梗死 (STEMI) 中非罪魁祸首病变的血流储备分数 (FFR) 引导与血管造影引导的血运重建。我们还评估了早期完全血运重建是否优于延迟血运重建。我们使用 Net Meta XL 对患有多支血管疾病的 STEMI 患者的试验进行了网络荟萃分析，并比较了血运重建策略。主要关注的结果是血运重建率、心肌梗死和全因死亡率。我们的分析中纳入了 10 项研究，其中包括 7981 名患者，其中 4484 名患者接受了完全血运重建，3497 名患者接受了单纯血运重建。使用 FFR 指导，全因死亡、心肌梗死或血运重建没有显着减少。与仅罪犯组相比，无论经皮冠状动脉介入治疗 (PCI) 的时间如何，重复血运重建和完全血运重建的次数均显着减少。总体趋势有利于早期血运重建。对于出现 ST 段抬高型心肌梗死的多支血管疾病患者，与单纯治疗相比，完全血运重建可显着减少重复血运重建。FFR 指导并不优于血管造影引导的血运重建。此外，无论对非肇事血管进行 PCI 的时间如何，重复血运重建的次数均显着减少。