Fractional flow reserve versus angiography for guiding percutaneous coronary intervention in patients with multivessel coronary artery disease: 2-year follow-up of the FAME (Fractional Flow Reserve Versus Angiography for Multivessel Evaluation) study.
|Abstract||The purpose of this study was to investigate the 2-year outcome of percutaneous coronary intervention (PCI) guided by fractional flow reserve (FFR) in patients with multivessel coronary artery disease (CAD).|
Rationale and design of the Fractional Flow Reserve versus Angiography for Multivessel Evaluation (FAME) 3 Trial: a comparison of fractional flow reserve-guided percutaneous coronary intervention and coronary artery bypass graft surgery in patients with multivessel coronary artery disease.
|Journal Title||journal of the american college of cardiology|
|Publication Year Start||2010-01-01|
PMID- 20537493 OWN - NLM STAT- MEDLINE DA - 20100712 DCOM- 20100730 LR - 20101118 IS - 1558-3597 (Electronic) IS - 0735-1097 (Linking) VI - 56 IP - 3 DP - 2010 Jul 13 TI - Fractional flow reserve versus angiography for guiding percutaneous coronary intervention in patients with multivessel coronary artery disease: 2-year follow-up of the FAME (Fractional Flow Reserve Versus Angiography for Multivessel Evaluation) study. PG - 177-84 LID - 10.1016/j.jacc.2010.04.012 [doi] AB - OBJECTIVES: The purpose of this study was to investigate the 2-year outcome of percutaneous coronary intervention (PCI) guided by fractional flow reserve (FFR) in patients with multivessel coronary artery disease (CAD). BACKGROUND: In patients with multivessel CAD undergoing PCI, coronary angiography is the standard method for guiding stent placement. The FAME (Fractional Flow Reserve Versus Angiography for Multivessel Evaluation) study showed that routine FFR in addition to angiography improves outcomes of PCI at 1 year. It is unknown if these favorable results are maintained at 2 years of follow-up. METHODS: At 20 U.S. and European medical centers, 1,005 patients with multivessel CAD were randomly assigned to PCI with drug-eluting stents guided by angiography alone or guided by FFR measurements. Before randomization, lesions requiring PCI were identified based on their angiographic appearance. Patients randomized to angiography-guided PCI underwent stenting of all indicated lesions, whereas those randomized to FFR-guided PCI underwent stenting of indicated lesions only if the FFR was <or=0.80. RESULTS: The number of indicated lesions was 2.7+/-0.9 in the angiography-guided group and 2.8+/-1.0 in the FFR-guided group (p=0.34). The number of stents used was 2.7+/-1.2 and 1.9+/-1.3, respectively (p<0.001). The 2-year rates of mortality or myocardial infarction were 12.9% in the angiography-guided group and 8.4% in the FFR-guided group (p=0.02). Rates of PCI or coronary artery bypass surgery were 12.7% and 10.6%, respectively (p=0.30). Combined rates of death, nonfatal myocardial infarction, and revascularization were 22.4% and 17.9%, respectively (p=0.08). For lesions deferred on the basis of FFR>0.80, the rate of myocardial infarction was 0.2% and the rate of revascularization was 3.2 % after 2 years. CONCLUSIONS: Routine measurement of FFR in patients with multivessel CAD undergoing PCI with drug-eluting stents significantly reduces mortality and myocardial infarction at 2 years when compared with standard angiography-guided PCI. (Fractional Flow Reserve Versus Angiography for Multivessel Evaluation [FAME]; NCT00267774). CI - Copyright (c) 2010 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved. FAU - Pijls, Nico H J AU - Pijls NH AD - Catharina Hospital, Department of Cardiology, Eindhoven, the Netherlands. [email protected] FAU - Fearon, William F AU - Fearon WF FAU - Tonino, Pim A L AU - Tonino PA FAU - Siebert, Uwe AU - Siebert U FAU - Ikeno, Fumiaki AU - Ikeno F FAU - Bornschein, Bernhard AU - Bornschein B FAU - van't Veer, Marcel AU - van't Veer M FAU - Klauss, Volker AU - Klauss V FAU - Manoharan, Ganesh AU - Manoharan G FAU - Engstrom, Thomas AU - Engstrom T FAU - Oldroyd, Keith G AU - Oldroyd KG FAU - Ver Lee, Peter N AU - Ver Lee PN FAU - MacCarthy, Philip A AU - MacCarthy PA FAU - De Bruyne, Bernard AU - De Bruyne B CN - FAME Study Investigators LA - eng SI - ClinicalTrials.gov/NCT00267774 PT - Comparative Study PT - Journal Article PT - Multicenter Study PT - Randomized Controlled Trial PT - Research Support, Non-U.S. Gov't DEP - 20100528 PL - United States TA - J Am Coll Cardiol JT - Journal of the American College of Cardiology JID - 8301365 SB - AIM SB - IM MH - Angioplasty, Balloon, Coronary/*methods MH - *Coronary Angiography MH - Coronary Disease/surgery/*therapy MH - *Drug-Eluting Stents MH - Female MH - Follow-Up Studies MH - Fractional Flow Reserve, Myocardial/*physiology MH - Humans MH - Male MH - Middle Aged MH - Myocardial Infarction/mortality MH - Treatment Outcome EDAT- 2010/06/12 06:00 MHDA- 2010/07/31 06:00 CRDT- 2010/06/12 06:00 PHST- 2009/12/08 [received] PHST- 2010/04/06 [revised] PHST- 2010/04/14 [accepted] PHST- 2010/05/28 [aheadofprint] AID - S0735-1097(10)01602-5 [pii] AID - 10.1016/j.jacc.2010.04.012 [doi] PST - ppublish SO - J Am Coll Cardiol. 2010 Jul 13;56(3):177-84. doi: 10.1016/j.jacc.2010.04.012. Epub 2010 May 28.
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