{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T22:18:48Z","timestamp":1789510728536,"version":"build-2803163510"},"reference-count":47,"publisher":"American Medical Association (AMA)","issue":"18","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA"],"published-print":{"date-parts":[[2025,11,11]]},"abstract":"<jats:sec>\n                    <jats:title>Importance<\/jats:title>\n                    <jats:p>The benefits of fractional flow reserve (FFR)\u2013guided complete coronary revascularization in patients with non\u2013ST-segment elevation myocardial infarction (NSTEMI) and multivessel disease remain unclear.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To compare FFR-guided complete revascularization of nonculprit lesions vs culprit-only revascularization in patients with NSTEMI and multivessel disease.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design, Setting, and Participants<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Intervention<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main Outcomes and Measures<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      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];\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u2009.003). Rates of any revascularization (3.0% vs 11.5%; HR, 0.24 [95% CI, 0.11-0.56];\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&amp;amp;lt;\u2009.001) and net adverse clinical events (6.3% vs 15.3%; HR, 0.39 [95% CI, 0.21-0.70];\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u2009.002) were also significantly lower in the complete revascularization group, while there were no significant differences in the remaining secondary outcomes.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion and Relevance<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial Registration<\/jats:title>\n                    <jats:p>\n                      ClinicalTrials.gov Identifier:\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/clinicaltrials.gov\/study\/NCT03562572\">NCT03562572<\/jats:ext-link>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1001\/jama.2025.16189","type":"journal-article","created":{"date-parts":[[2025,8,31]],"date-time":"2025-08-31T16:30:16Z","timestamp":1756657816000},"page":"1628","source":"Crossref","is-referenced-by-count":11,"title":["Fractional Flow Reserve\u2013Guided Complete vs Culprit-Only Revascularization in Non\u2013ST-Elevation Myocardial Infarction and Multivessel Disease"],"prefix":"10.1001","volume":"334","author":[{"given":"Tobias F.S.","family":"Pustjens","sequence":"first","affiliation":[{"name":"Department of Cardiology, Zuyderland Medical Centre, Heerlen, the Netherlands"},{"name":"Department of Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, the Netherlands"},{"name":"Department of Cardiology, Maastricht University Medical Centre, Maastricht, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leo","family":"Veenstra","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Zuyderland Medical Centre, Heerlen, the Netherlands"},{"name":"Department of Cardiology, Maastricht University Medical Centre, Maastricht, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cyril","family":"Camaro","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Radboud University Medical Centre, Nijmegen, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander W.","family":"Ruiters","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Zuyderland Medical Centre, Heerlen, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"\u00c1rpad","family":"Lux","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, the Netherlands"},{"name":"Department of Cardiology, Maastricht University Medical Centre, Maastricht, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zolt\u00e1n","family":"Ruzsa","sequence":"additional","affiliation":[{"name":"Invasive Cardiology Division, Internal Medicine Department, University of Szeged, Szeged, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zsolt","family":"Piroth","sequence":"additional","affiliation":[{"name":"Hungarian Institute of Cardiology, Budapest, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mustafa","family":"Ilhan","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Zuyderland Medical Centre, Heerlen, the Netherlands"},{"name":"Department of Cardiology, Maastricht University Medical Centre, Maastricht, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jindrich","family":"Vainer","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Maastricht University Medical Centre, Maastricht, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ben","family":"Gho","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Zuyderland Medical Centre, Heerlen, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patty J. 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