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Fractional flow reserve in unstable angina and non-ST-segment elevation myocardial infarction experience from the FAME (Fractional flow reserve versus Angiography for Multivessel Evaluation) study.

Abstract The aim of this study was to study whether there is a difference in benefit of fractional flow reserve (FFR) guidance for percutaneous coronary intervention (PCI) in multivessel coronary disease in patients with unstable angina (UA) or non-ST-segment elevation myocardial infarction (NSTEMI), compared with stable angina (SA).
PMID
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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.

Authors

Mayor MeshTerms

Angioplasty, Balloon, Coronary

Coronary Angiography

Fractional Flow Reserve, Myocardial

Keywords
Journal Title jacc. cardiovascular interventions
Publication Year Start




PMID- 22115657
OWN - NLM
STAT- MEDLINE
DA  - 20111125
DCOM- 20120325
LR  - 20140905
IS  - 1876-7605 (Electronic)
IS  - 1936-8798 (Linking)
VI  - 4
IP  - 11
DP  - 2011 Nov
TI  - Fractional flow reserve in unstable angina and non-ST-segment elevation
      myocardial infarction experience from the FAME (Fractional flow reserve versus
      Angiography for Multivessel Evaluation) study.
PG  - 1183-9
LID - 10.1016/j.jcin.2011.08.008 [doi]
AB  - OBJECTIVES: The aim of this study was to study whether there is a difference in
      benefit of fractional flow reserve (FFR) guidance for percutaneous coronary
      intervention (PCI) in multivessel coronary disease in patients with unstable
      angina (UA) or non-ST-segment elevation myocardial infarction (NSTEMI), compared 
      with stable angina (SA). BACKGROUND: The use of FFR to guide PCI has been well
      established for patients with SA. Its use in patients with UA or NSTEMI has not
      been investigated prospectively. METHODS: In the FAME (Fractional flow reserve
      versus Angiography for Multivessel Evaluation) study 1,005 patients with
      multivessel disease amenable to PCI were included and randomized to either
      angiography-guided PCI of all lesions >/=50% or FFR-guided PCI of lesions with an
      FFR </=0.80. Patients admitted for UA or NSTEMI with positive troponin but total 
      creatine kinase <1,000 U/l were eligible for inclusion. We determined 2-year
      major adverse cardiac event rates of these patients and compared it with stable
      patients. RESULTS: Of 1,005 patients, 328 had UA or NSTEMI. There was no evidence
      for heterogeneity among the subgroups for any of the outcome variables (all p
      values >0.05). Using FFR to guide PCI resulted in similar risk reductions of
      major adverse cardiac events and its components in patients with UA or NSTEMI,
      compared with patients with SA (absolute risk reduction of 5.1% vs. 3.7%,
      respectively, p = 0.92). In patients with UA or NSTEMI, the number of stents was 
      reduced without increase in hospital stay or procedure time and with less
      contrast use, in similarity to stable patients. CONCLUSIONS: The benefit of using
      FFR to guide PCI in multivessel disease does not differ between patients with UA 
      or NSTEMI, compared with patients with SA.
CI  - Copyright (c) 2011 American College of Cardiology Foundation. Published by
      Elsevier Inc. All rights reserved.
FAU - Sels, Jan-Willem E M
AU  - Sels JW
AD  - Catharina Hospital, Eindhoven, the Netherlands.
FAU - Tonino, Pim A L
AU  - Tonino PA
FAU - Siebert, Uwe
AU  - Siebert U
FAU - Fearon, William F
AU  - Fearon WF
FAU - Van't Veer, Marcel
AU  - Van't Veer M
FAU - De Bruyne, Bernard
AU  - De Bruyne B
FAU - Pijls, Nico H J
AU  - Pijls NH
LA  - ENG
PT  - Comparative Study
PT  - Journal Article
PT  - Multicenter Study
PT  - Randomized Controlled Trial
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - JACC Cardiovasc Interv
JT  - JACC. Cardiovascular interventions
JID - 101467004
SB  - IM
MH  - Aged
MH  - Angina, Unstable/mortality/*physiopathology/radiography/*therapy
MH  - *Angioplasty, Balloon, Coronary/adverse effects/instrumentation/mortality
MH  - Chi-Square Distribution
MH  - *Coronary Angiography
MH  - Coronary Artery Disease/mortality/*physiopathology/radiography/*therapy
MH  - Female
MH  - *Fractional Flow Reserve, Myocardial
MH  - Heart Diseases/etiology
MH  - Humans
MH  - Kaplan-Meier Estimate
MH  - Length of Stay
MH  - Male
MH  - Middle Aged
MH  - Myocardial Infarction/mortality/*physiopathology/radiography/*therapy
MH  - Predictive Value of Tests
MH  - Prospective Studies
MH  - Risk Assessment
MH  - Risk Factors
MH  - Stents
MH  - Treatment Outcome
EDAT- 2011/11/26 06:00
MHDA- 2012/03/27 06:00
CRDT- 2011/11/26 06:00
PHST- 2011/04/22 [received]
PHST- 2011/08/02 [revised]
PHST- 2011/08/04 [accepted]
AID - S1936-8798(11)00694-7 [pii]
AID - 10.1016/j.jcin.2011.08.008 [doi]
PST - ppublish
SO  - JACC Cardiovasc Interv. 2011 Nov;4(11):1183-9. doi: 10.1016/j.jcin.2011.08.008.

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