COMPARISON OF ANGIOGRAPHIC EVALUATION AND HEMODYNAMIC MEASUREMENT OF THE SIGNIFICANCE OF NON INFARCT-RELATED RESIDUAL STENOSIS IN STEMI PATIENTS - SINGLE CENTER EXPERIENCE.

Introduction: Up to 50% of patients with STEMI have >50% stenosis in a major non-infarct related artery. Several studies have evaluated the prognostic value of completion of revascularization using selection based on angiographic evaluation, invasive hemodynamic measurement with fractional flow reserve (FFR) or combined approach (1-5). In our single center study, we compared subjective angiographic evaluation with invasive hemodynamic measurement.
Methods: We examined 51 patients (62,7 ± 10,2 years) with acute STEMI who had at least one residual (50-90%) stenosis in non infarct-related major coronary artery (excluding left main coronary artery). Overall 65 stenoses (67,9 ± 10,7%) were evaluated angiographically during primary PCI and were recommended for either completion of revascularization or conservative approach taking into consideration stenosis severity, localization of stenosis (proximity) as well as the supplied vascular territory. During subsequent rehospitalization, invasive measurement of hemodynamic significance using FFR was performed and guided the final revascularization strategy (FFR value of ≤0.80 considered significant).
Results: Based on angiographic evaluation, a total of 44 stenoses were recommended for treatment, whereas only 31 stenoses were revascularized based on FFR measurement. Moreover, subjective evaluation and hemodynamic measurement were discrepant in 27 out of 65 (41.5%) stenoses.
Conclusion: We observed weak correlation between subjective angiographic evaluation and invasive hemodynamic measurement. More stents would be used based on angiographic evaluation compared to FFR measurement.

Supported by MH CZ – DRO (FNOl, 00098892)