Immediate or Deferred Nonculprit-Lesion PCI in Myocardial Infarction.

A comparison of immediate percutaneous coronary intervention (PCI) guided by instantaneous wave-free ratio (iFR) and deferred PCI guided by cardiac stress magnetic resonance imaging (MRI) in patients with STEMI and multivessel disease is warranted.

对于STEMI合并多支血管疾病的患者，有必要比较即时经皮冠状动脉介入治疗（PCI），该治疗以瞬时无波比率（iFR）为指导，与延迟PCI，该治疗以心脏应激磁共振成像（MRI）为指导。

Methods

In this international, investigator-initiated, open-label, randomized, controlled trial, patients with STEMI and at least one nonculprit lesion who had undergone successful primary PCI were randomly assigned in a 1:1 ratio to immediate iFR-guided PCI (in lesions with >50% stenosis and an iFR of ≤0.89 [normal value, >0.89]) or deferred cardiac stress MRI-guided PCI within 6 weeks after randomization.

在这项国际性、研究者发起的、开放标签、随机对照试验中，接受成功的主要经皮冠状动脉介入治疗（PCI）的ST段抬高型心肌梗死（STEMI）患者，且至少有一个非罪犯病变，被以1:1的比例随机分配至立即进行瞬时无波形比率（iFR）指导的PCI（对于狭窄>50%且iFR≤0.89[正常值，>0.89]的病变）或在随机化后6周内延迟进行心脏应激磁共振成像（MRI）指导的PCI。

The primary end point was a composite of death from any cause, recurrent myocardial infarction, or hospitalization for heart failure at 3-year follow-up.

主要终点是3年随访期间由任何原因导致的死亡、复发性心肌梗死或因心力衰竭住院的复合终点。

Results

The trial included 1146 patients (558 in the iFR group and 588 in the MRI group) with a mean (±SD) age of 63±11 years; 78% were men.

该试验纳入了1146名患者（iFR组558人，MRI组588人），平均（±标准差）年龄为63±11岁；其中78%为男性。

A total of 237 of 556 patients (42.6%) in the iFR group and 110 of 587 patients (18.7%) in the MRI group underwent nonculprit-lesion coronary-artery PCI.

在iFR组的556名患者中，共有237名（42.6%）接受了非罪犯病变冠状动脉PCI治疗；而在MRI组的587名患者中，有110名（18.7%）接受了该治疗。

A primary-end-point event occurred in 50 patients (9.3%) in the iFR group and in 55 patients (9.8%) in the MRI group (hazard ratio, 0.95; 95% confidence interval, 0.65 to 1.40; P = 0.81).

在iFR组有50名患者（9.3%）和在MRI组有55名患者（9.8%）发生了主要终点事件（风险比，0.95；95%置信区间，0.65至1.40；P = 0.81）。

Serious adverse events occurred in 145 patients in the iFR group and in 181 in the MRI group.

在iFR组有145名患者和在MRI组有181名患者发生了严重不良事件。

Conclusions

Among patients with STEMI who have undergone successful primary PCI, immediate iFR-guided PCI was not superior to deferred cardiac stress MRI-guided PCI of nonculprit coronary-artery lesions with respect to death from any cause, recurrent myocardial infarction, or hospitalization for heart failure at 3 years.

在成功接受初级经皮冠状动脉介入治疗（PCI）的ST段抬高型心肌梗死（STEMI）患者中，即时使用瞬时无波导引（iFR）的PCI与延迟使用心脏应激磁共振成像（MRI）指导的非罪犯冠状动脉病变PCI在3年内全因死亡、复发性心肌梗死或因心力衰竭住院方面并无优势。

(Funded by Philips Volcano and others; iMODERN ClinicalTrials.gov number, NCT03298659.).

(该研究由飞利浦火山公司等资助；iMODERN临床试验注册号，NCT03298659。)