Function-Guided Complete Revascularization Improves Outcomes in STEMI

In patients with ST-segment elevation myocardial infarction (STEMI) and multivessel coronary artery disease, complete coronary revascularization guided by functional coronary angiography significantly reduced both major cardiovascular events and key safety events compared with conventional angiography-guided treatment. In this international randomized trial, 1,823 patients whose culprit lesion had been successfully treated were assigned to function-guided or conventional angiography-guided complete revascularization. The primary composite outcome of death from any cause, myocardial infarction, cerebrovascular events, or ischemia-driven revascularization occurred in 8.9% of the function-guided group versus 13.7% of the angiography-guided group at a median follow-up of 17.9 months (hazard ratio [HR], 0.62). The primary safety outcome, a composite of contrast-associated acute kidney injury or major bleeding, also occurred less frequently with functional guidance (4.6% vs. 7.1%; HR, 0.63). These findings indicate that, among patients with STEMI and multivessel disease, using functional coronary angiography to guide complete revascularization provides better clinical outcomes than relying on conventional angiography alone. Source: https://www.nejm.org/