Cardiology Today's Intervention highlights 5 articles relating to multivessel disease

Cardiology Today’s Intervention compiled a list stories posted to Healio.com/Intervention relating to interventions for patients with multivessel disease.

Highlights include results of the FUTURE trial, a feature on the complete revascularization in multivessel CAD, results from the COMPARE-ACUTE trial and much more.

Mortality link with FFR questioned in FUTURE trial

NEW ORLEANS — The FUTURE trial, designed to evaluate the impact of therapeutic management of patients with stabilized angina and multivessel CAD guided by fractional flow reserve or conventional angiography, was halted early due to an excess of all-cause mortality among patients who received the FFR strategy.

However, follow-up data on available patients enrolled before the study stopped showed a persistent but nonsignificant difference in all-cause mortality at 1 year between the two groups.

Complete r evasc ularization in multivessel CAD remains v exing

Patients with multivessel CAD are at higher risk for worse short- and long-term outcomes after STEMI. Although primary PCI is the preferred treatment for STEMI, questions persist about how to approach revascularization in patients with STEMI in one lesion and at least one nonculprit lesion.

Recent data from clinical trials, including CvLPRIT, PRAMI and DANAMI3-PRIMULTI, indicate that complete revascularization may be beneficial. Some evidence also suggests that performing the procedure in multiple stages — addressing the culprit lesion during the index procedure and treating the nonculprit lesions during a separate procedure — may lead to better outcomes. Additionally, an update to the American College of Cardiology/American Heart Association/Society for Cardiovascular Angiography and Interventions guideline on primary PCI in patients with STEMI now gives a class IIb recommendation, as opposed to a class III recommendation, to stenting nonculprit lesions in patients who are hemodynamically stable.

COMPARE-ACUTE: FFR-guided complete revascularization linked to lower risk for adverse events

WASHINGTON — In patients with STEMI and multivessel disease, complete revascularization guided by FFR was associated with reduced adverse events compared with PCI of an infarct-related artery only, according to data presented by Pieter Smits, MD, PhD.

“Approximately 50% of STEMI patients have multivessel disease at presentation,” Smits, of Maasstad Ziekenhuis in Rotterdam, the Netherlands, said during his presentation of the COMPARE-ACUTE results at the American College of Cardiology Scientific Session. “What to do with these noninfarct-related artery lesions and when remain an unresolved clinical dilemma.”

After PCI, diabetes linked to higher mortality only in insulin-treated patients

Among patients undergoing PCI for stable CAD or ACS, diabetic status was associated with higher mortality only in those treated with insulin, according to recent findings.

In the retrospective analysis, researchers assessed prospectively culled data on 9,224 patients who underwent PCI between March 2008 and December 2011 at a tertiary center in Newcastle-upon Tyne, United Kingdom. The patient population consisted of 7,652 nondiabetic patients, 1,116 patients with diabetes not being treated with insulin and 456 patients with diabetes being treated with insulin. Diabetes was associated with multivessel CAD.

Staged intervention may benefit patients with STEMI undergoing PCI

Culprit vessel intervention with staged revascularization may be the optimal primary PCI strategy for some patients with STEMI, according to new findings.

M. Bilal Iqbal, MD, PhD, and colleagues compared 2-year all-cause mortality and repeat revascularization between patients who underwent one of three PCI strategies: multivessel intervention, culprit vessel intervention only or culprit vessel intervention with staged revascularization.