4. Discussion
thrombosis, ischemia-driven, cardiovascular death, MIs, perforation, CAD, no-reflow, coronary perforations, deaths, coronary perforation, contrast-induced nephropathy
THROMBOSIS, MYOCARDIAL INFARCTION (MI), CARDIAC DEATH, COMPLICATIONS, VASCULAR ACCESS SITE COMPLICATION, CAD, CONTRAST-INDUCED NEPHROPATHY
In this pilot study, the iFR-guided and virtual planning tool-optimized PCI strategy was tested for safety and feasibility as a revascularization strategy in patients with MV ACS. Despite its significantly longer procedure and higher volume of the contrast medium delivered at the index PCI, there were no significant differences in safety endpoints (PCI-related MACEs comprising of cardiac death, non-fatal myocardial infarction (MI), unplanned revascularization, stent thrombosis, flow limiting coronary dissections, no-reflow phenomenon, coronary perforations, coronary distal embolization, vascular access site complications requiring blood transfusion or surgical intervention, and contrast-induced nephropathy requiring hospitalization) between the angiography and iFR-guided groups at the 3-month follow-up. Furthermore, except for two cases of distal embolization in the iFR group, and one case of flow-limiting coronary dissection in the angiography-guided group during the second revascularization stage, there were no cardiovascular deaths or non-fatal MIs, and no patients needed unplanned revascularization. Moreover, there were no cases of no-reflow phenomenon, coronary perforation, stent thrombosis, contrast-induced nephropathy requiring hospitalization, and vascular access site complications requiring blood transfusion or surgical intervention.Overall, using invasive physiological coronary blood flow indices to assess lesion functional significance improves clinical outcomes in patients with MV CAD [Both FFR and iFR methods showed comparable results and diagnostic accuracy for non-culprit lesion assessment in the WAVE study in patients with STEMI [Regarding the treatment of non-culprit arteries, the currently available evidence indicates that complete revascularization PCI is better than culprit-only revascularization for MV CAD. The COMPLETE trial demonstrated that complete revascularization for STEMI significantly reduced coprimary outcomes, including cardiovascular death, MI, and ischemia-driven revascularization [In this study angiography-guided staged PCI strategy had a tendency towards longer overall hospital stay needed for complete revascularization. Additionally, iFR-guided PCI enabled complete revascularization in a single stage, demonstrating a significantly reduced number of PCIs needed in achievement of complete revascularization. This indicates several potential benefits in terms of the overall PCI-related risk since each procedure is associated with potential risks of vessel dissection, perforation, and hemodynamic complications [