Fractional Flow Reserve-Guided Complete vs Culprit-Only
Revascularization in Non-ST-Elevation Myocardial Infarction and
Multivessel Disease The SLIM Randomized Clinical Trial

J 2025

Fractional Flow Reserve-Guided Complete vs Culprit-Only Revascularization in Non-ST-Elevation Myocardial Infarction and Multivessel Disease The SLIM Randomized Clinical Trial

PUSTJENS, Tobias F S; Leo VEENSTRA; Cyril CAMARO; Alexander W RUITERS; Arpad LUX et al.

Základní údaje

Originální název

Fractional Flow Reserve-Guided Complete vs Culprit-Only Revascularization in Non-ST-Elevation Myocardial Infarction and Multivessel Disease The SLIM Randomized Clinical Trial

Autoři

Vydání

JAMA-Journal of the American Medical Association, Chicago, USA, American Medical Association, 2025, 0098-7484

Další údaje

Jazyk

angličtina

Typ výsledku

Článek v odborném periodiku

Obor

30201 Cardiac and Cardiovascular systems

Stát vydavatele

Spojené státy

Utajení

není předmětem státního či obchodního tajemství

Odkazy

URL

Impakt faktor

Impact factor: 55.000 v roce 2024

Označené pro přenos do RIV

Ano

Organizační jednotka

Lékařská fakulta

Klíčová slova anglicky

Fractional Flow Reserve; Non-ST-Elevation Myocardial Infarction; Multivessel Disease; Complete Revascularization; Randomized Clinical Trial

Štítky

14110211, rivok

Příznaky

Mezinárodní význam, Recenzováno

Změněno: 16. 1. 2026 14:11, Mgr. Tereza Miškechová

Anotace

V originále

IMPORTANCE The benefits of fractional flow reserve (FFR)-guided complete coronary revascularization in patients with non-ST-segment elevation myocardial infarction (NSTEMI) and multivessel disease remain unclear. OBJECTIVE To compare FFR-guided complete revascularization of nonculprit lesions vs culprit-only revascularization in patients with NSTEMI and multivessel disease. DESIGN, SETTING, AND PARTICIPANTS This prospective, investigator-initiated, multicenter, international randomized clinical trial was conducted at 9 hospitals in Europe. Patients with NSTEMI and multivessel disease who had successful revascularization of the culprit lesion were enrolled between June 2018 and July 2024, and final follow-up was completed on July 21, 2025. The analysis was conducted on July 28, 2025. Eligibility criteria included the presence of at least 1 stenosis of at least 50% in a nonculprit lesion amendable for revascularization. INTERVENTION Patients were randomized to receive either FFR-guided complete or culprit-only revascularization during the index procedure. Staged revascularization within 6 weeks after the index procedure was allowed in the culprit-only group. MAIN OUTCOMES AND MEASURES The primary outcome was a composite of all-cause death, nonfatal myocardial infarction, any revascularization, and stroke at 1 year. Key secondary outcomes included individual components of the primary outcome, net adverse clinical events, all-cause death or nonfatal myocardial infarction, cardiac rehospitalization, and bleeding events. RESULTS Among 478 randomized patients (mean [SD] age, 65.9 [10.6] years; 347 [72.9%] males), 240 were randomized to receive FFR-guided complete revascularization and 238 were randomized to receive culprit-only revascularization, with crossover occurring in 7 patients in the culprit-only group. The primary outcome occurred in 13 patients (5.5%) in the FFR-guided complete revascularization group vs 32 patients (13.6%) in the culprit-only group (hazard ratio [HR], 0.38 [95% CI, 0.20-0.72]; P = .003). Rates of any revascularization (3.0% vs 11.5%; HR, 0.24 [95% CI, 0.11-0.56]; P < .001) and net adverse clinical events (6.3% vs 15.3%; HR, 0.39 [95% CI, 0.21-0.70]; P = .002) were also significantly lower in the complete revascularization group, while there were no significant differences in the remaining secondary outcomes. CONCLUSION AND RELEVANCE FFR-guided complete revascularization during the index procedure resulted in a significant reduction in the composite of all-cause death, nonfatal myocardial infarction, any revascularization, and stroke at 1 year. This was mainly driven by reduced repeat revascularization.

Citovat

PUSTJENS, Tobias F S; Leo VEENSTRA; Cyril CAMARO; Alexander W RUITERS; Arpad LUX; Zoltan RUZSA; Zsolt PIROTH; Mustafa ILHAN; Jindrich VAINER; Ben GHO; Patty J C WINKLER; Mera STEIN; Ralph A L J THEUNISSEN; Petr KALA; Jawed POLAD; Balazs BERTA; Andrea GABRIO; van Royen NIELS; J W VAN 'T HOF ARNOUD a Saman RASOUL. Fractional Flow Reserve-Guided Complete vs Culprit-Only Revascularization in Non-ST-Elevation Myocardial Infarction and Multivessel Disease The SLIM Randomized Clinical Trial. JAMA-Journal of the American Medical Association. Chicago, USA: American Medical Association, 2025, roč. 334, č. 18, s. 1628-1637. ISSN 0098-7484. Dostupné z: https://doi.org/10.1001/jama.2025.16189.

@article{2547642,
   author = {Pustjens, Tobias F S and Veenstra, Leo and Camaro, Cyril and Ruiters, Alexander W and Lux, Arpad and Ruzsa, Zoltan and Piroth, Zsolt and Ilhan, Mustafa and Vainer, Jindrich and Gho, Ben and Winkler, Patty J C and Stein, Mera and Theunissen, Ralph A L J and Kala, Petr and Polad, Jawed and Berta, Balazs and Gabrio, Andrea and Niels, van Royen and van 't Hof Arnoud, J W and Rasoul, Saman},
   article_location = {Chicago, USA},
   article_number = {18},
   doi = {https://doi.org/10.1001/jama.2025.16189},
   keywords = {Fractional Flow Reserve; Non-ST-Elevation Myocardial Infarction; Multivessel Disease; Complete Revascularization; Randomized Clinical Trial},
   language = {eng},
   issn = {0098-7484},
   journal = {JAMA-Journal of the American Medical Association},
   title = {Fractional Flow Reserve-Guided Complete vs Culprit-Only Revascularization in Non-ST-Elevation Myocardial Infarction and Multivessel Disease The SLIM Randomized Clinical Trial},
   url = {https://jamanetwork.com/journals/jama/fullarticle/2838519},
   volume = {334},
   year = {2025}
}

TY  - JOUR
ID  - 2547642
AU  - Pustjens, Tobias F S - Veenstra, Leo - Camaro, Cyril - Ruiters, Alexander W - Lux, Arpad - Ruzsa, Zoltan - Piroth, Zsolt - Ilhan, Mustafa - Vainer, Jindrich - Gho, Ben - Winkler, Patty J C - Stein, Mera - Theunissen, Ralph A L J - Kala, Petr - Polad, Jawed - Berta, Balazs - Gabrio, Andrea - Niels, van Royen - van 't Hof Arnoud, J W - Rasoul, Saman
PY  - 2025
TI  - Fractional Flow Reserve-Guided Complete vs Culprit-Only Revascularization in Non-ST-Elevation Myocardial Infarction and Multivessel Disease The SLIM Randomized Clinical Trial
JF  - JAMA-Journal of the American Medical Association
VL  - 334
IS  - 18
SP  - 1628-1637
EP  - 1628-1637
PB  - American Medical Association
SN  - 00987484
KW  - Fractional Flow Reserve
KW  - Non-ST-Elevation Myocardial Infarction
KW  - Multivessel Disease
KW  - Complete Revascularization
KW  - Randomized Clinical Trial
UR  - https://jamanetwork.com/journals/jama/fullarticle/2838519
N2  - IMPORTANCE The benefits of fractional flow reserve (FFR)-guided complete coronary revascularization in patients with non-ST-segment elevation myocardial infarction (NSTEMI) and multivessel disease remain unclear. OBJECTIVE To compare FFR-guided complete revascularization of nonculprit lesions vs culprit-only revascularization in patients with NSTEMI and multivessel disease. DESIGN, SETTING, AND PARTICIPANTS This prospective, investigator-initiated, multicenter, international randomized clinical trial was conducted at 9 hospitals in Europe. Patients with NSTEMI and multivessel disease who had successful revascularization of the culprit lesion were enrolled between June 2018 and July 2024, and final follow-up was completed on July 21, 2025. The analysis was conducted on July 28, 2025. Eligibility criteria included the presence of at least 1 stenosis of at least 50% in a nonculprit lesion amendable for revascularization. INTERVENTION Patients were randomized to receive either FFR-guided complete or culprit-only revascularization during the index procedure. Staged revascularization within 6 weeks after the index procedure was allowed in the culprit-only group. MAIN OUTCOMES AND MEASURES The primary outcome was a composite of all-cause death, nonfatal myocardial infarction, any revascularization, and stroke at 1 year. Key secondary outcomes included individual components of the primary outcome, net adverse clinical events, all-cause death or nonfatal myocardial infarction, cardiac rehospitalization, and bleeding events. RESULTS Among 478 randomized patients (mean [SD] age, 65.9 [10.6] years; 347 [72.9%] males), 240 were randomized to receive FFR-guided complete revascularization and 238 were randomized to receive culprit-only revascularization, with crossover occurring in 7 patients in the culprit-only group. The primary outcome occurred in 13 patients (5.5%) in the FFR-guided complete revascularization group vs 32 patients (13.6%) in the culprit-only group (hazard ratio [HR], 0.38 [95% CI, 0.20-0.72]; P = .003). Rates of any revascularization (3.0% vs 11.5%; HR, 0.24 [95% CI, 0.11-0.56]; P < .001) and net adverse clinical events (6.3% vs 15.3%; HR, 0.39 [95% CI, 0.21-0.70]; P = .002) were also significantly lower in the complete revascularization group, while there were no significant differences in the remaining secondary outcomes. CONCLUSION AND RELEVANCE FFR-guided complete revascularization during the index procedure resulted in a significant reduction in the composite of all-cause death, nonfatal myocardial infarction, any revascularization, and stroke at 1 year. This was mainly driven by reduced repeat revascularization.
ER  -

PUSTJENS, Tobias F S; Leo VEENSTRA; Cyril CAMARO; Alexander W RUITERS; Arpad LUX; Zoltan RUZSA; Zsolt PIROTH; Mustafa ILHAN; Jindrich VAINER; Ben GHO; Patty J C WINKLER; Mera STEIN; Ralph A L J THEUNISSEN; Petr KALA; Jawed POLAD; Balazs BERTA; Andrea GABRIO; van Royen NIELS; J W VAN 'T HOF ARNOUD a Saman RASOUL. Fractional Flow Reserve-Guided Complete vs Culprit-Only Revascularization in Non-ST-Elevation Myocardial Infarction and Multivessel Disease The SLIM Randomized Clinical Trial. \textit{JAMA-Journal of the American Medical Association}. Chicago, USA: American Medical Association, 2025, roč.~334, č.~18, s.~1628-1637. ISSN~0098-7484. Dostupné z: https://doi.org/10.1001/jama.2025.16189.

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