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

Catharina Hospital, Department of Cardiology, Eindhoven, the Netherlands.
Journal of the American College of Cardiology (Impact Factor: 16.5). 07/2010; 56(3):177-84. DOI: 10.1016/j.jacc.2010.04.012
Source: PubMed


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).
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.
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.
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.
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).

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    • "http://eurheartj long-ref-6Recent studies however, have used FFR ≤0.80 as the optimal cut-off point to guide revascularisation [4]. Although clinical decision making based on FFR can be safely made with a good predictive value, it does not provide morphological and anatomical information. "
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    ABSTRACT: The appropriate assessment of intermediate coronary artery stenosis continues to be a challenge for cardiologists. Several studies have shown that anatomic parameters obtained by intravascular ultrasound (IVUS) and optical coherence tomography (OCT) showed a correlation with fractional flow reserve (FFR) values in identifying hemodynamically severe coronary stenoses. However, the efficacy of IVUS/OCT versus FFR integration in intermediate coronary lesions is still debated. This review will allow for an independent analysis of research data and outlines the diagnostic efficiency of IVUS and OCT derived-anatomical parameters in identifying the hemodynamic significance of an angiographically intermediate stenosis as determined by FFR.
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    • "These CAD variables are provided by multiple approaches such as anatomical information including the presence, extent, and severity of CAD, hemodynamic information, and coronary plaque vulnerability, which all have been widely used for risk discrimination and stratification. The recent FAME trials raised an important question regarding guiding medical management for patients who would receive benefits from revascularization based on hemodynamic or anatomical significance of CAD [1, 2]. Also, the PROSPECT study demonstrated the importance to investigate coronary plaque morphology including the severity, volume, and vulnerability provided by intravascular ultrasound (IVUS) in predicting future cardiovascular risks [3]. "
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    • "The Fractional Flow Reserve Versus Angiograph for Multivessel Evaluation (FAME) study was a randomized, prospective, multicenter trial that investigated the benefits of FFR-guided PCI. This technique was associated with lesser stent implantation, less injection of contrast, and a reduction in adverse cardiac events, death, or myocardial infarction.47)48)49) This remarkable result supports the active use of FFR for assessing ischemia during intermediate coronary stenosis. "
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