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FLOWER-MI and the root of the problem with non-culprit revascularisation

Research output: Contribution to journalArticlepeer-review

Matthew E. Li Kam Wa, Kalpa de Silva, Carlos Collet, Divaka Perera

Original languageEnglish
Article number001763
JournalOpen Heart
Issue number2
Published24 Nov 2021

Bibliographical note

Funding Information: Funding ML, KDS and DP are supported by grants from the British Heart Foundation (RE/18/2/34213), and the UK National Institute for Health Research through the Biomedical Research Centre award to King’s College London and Guy’s and St Thomas’ NHS Foundation Trust. Publisher Copyright: © 2021 BMJ Publishing Group. All rights reserved.

King's Authors


How do we reduce cardiac death and myocardial infarction by percutaneous coronary intervention (PCI) in coronary heart disease? Although the interventional community continues to grapple with this question in stable angina, the benefits of PCI for non-culprit lesions found at ST-elevation myocardial infarction are established. Is it then wishful thinking that an index developed in stable coronary disease, for identifying lesions capable of causing ischaemia will show an incremental benefit over angiographically guided non-culprit PCI? This is the question posed by the recently published FLOW Evaluation to Guide Revascularization in Multi-vessel ST-elevation Myocardial Infarction (FLOWER-MI) trial. We examine the trial design and results; ask if there is any relationship between the baseline physiological significance of a non-culprit lesion and vulnerability to future myocardial infarction; and consider if more sophisticated methods can help guide or defer non-culprit revascularisation.

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