Fractional Flow Reserve–Guided PCI as Compared with Coronary Bypass Surgery

Fearon, William F.; Zimmermann, Frederik M.; Bruyne, Bernard De; Piróth, Zsolt; Straten, Albert H.M. van; Székely, L; Davidavičius, Giedrius; Kalinauskas, Gintaras; Mansour, Samer; Kharbanda, Rajesh; Östlund-Papadogeorgos, Nikolaos; Aminian, Adel; Oldroyd, Keith G.; Al‐Attar, Nawwar; Jagić, Nikola; Dambrink, Jan‐Henk E.; Kala, Petr; Angerås, Oskar; MacCarthy, Philip; Wendler, Olaf; Casselman, Filip; Witt, Nils; Mavromatis, Kreton; Miner, Steven E.S.; Sarma, Jaydeep; Engstrøm, Thomas; Christiansen, Evald; Tonino, Pim A.L.; Reardon, Michael J.; Lu, Di; Ding, Victoria; Kobayashi, Yuhei; Mark, Daniel B.; Mahaffey, Kenneth W.; Desai, Manisha; Woo, Y. Joseph; Yeung, Alan C.; Pijls, Nico H.J.; Investigators, Fame Study

doi:10.1056/nejmoa2112299

Cited by 212 publications

(124 citation statements)

References 19 publications

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“…Moreover, the risk of MACE was higher in PCI patients compared to CABG patients prior to the routine use of FFR (hazard ratio [HR] 1.82, 95% confidence interval [CI] 1.09 to 3.03, p = 0.021), and was not significantly different after routine incorporation of FFR (HR 1.22, 95% CI 0.59 to 2.52, p = 0.59). These results, however, were not reflected in the FAME 3 trial where FFR-guided PCI did not meet non-inferiority compared to CABG among patients with multivessel disease at 1 year follow-up [20]. Subgroup analysis did suggest that patients with a low SYNTAX score of 0-22 appeared to be a benefit from PCI versus CABG; however, further studies are needed to confirm these findings.…”

Section: Rationale For Physiologic Assessment Of Coronary Stenosesmentioning

confidence: 87%

Physiologic Lesion Assessment to Optimize Multivessel Disease

et al. 2022

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Purpose of Review Multivessel coronary artery disease, defined as significant stenosis in two or more major coronary arteries, is associated with high morbidity and mortality. The diagnosis and treatment of multivessel disease have evolved in the PCI era from solely a visual estimation of ischemic risk to a functional evaluation during angiography. This review summarizes the evidence and discusses the commonly used methods of multivessel coronary artery stenosis physiologic assessment. Recent Findings While FFR remains the gold standard in coronary physiologic assessment, several pressure-wire-based non-hyperemic indices of functional stenosis have been developed and validated as well as wire-free angiographically derived quantitative flow ratio. Identifying and treating functionally significant coronary atherosclerotic lesions reduce symptoms and major adverse cardiovascular events. Summary Coronary physiologic assessment in multivessel disease minimizes the observer bias in visual estimates of stenosis, changes clinical management, and improves patient outcomes.

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Section: Rationale For Physiologic Assessment Of Coronary Stenosesmentioning

confidence: 87%

Physiologic Lesion Assessment to Optimize Multivessel Disease

et al. 2022

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“…This line of argumentation finds supports in a meta-analysis we performed demonstrating an association of a survival advantage of CABG over PCI only in cases when there was also a difference in the rate of myocardial infarction 34 . This also highlights the importance of focusing on anatomically defined coronary artery disease, as recently published randomized data demonstrates that in patients with three-vessel coronary artery disease, the incidence of death, myocardial infarction, or stroke at one year was significantly lower for CABG compared to fractional flow reserve guided PCI 35 .…”

Section: Discussionmentioning

confidence: 83%

A systematic review and meta-analysis of percutaneous coronary intervention compared to coronary artery bypass grafting in non-ST-elevation acute coronary syndrome

Kirov

Caldonazo

Rahouma

et al. 2022

Sci Rep

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Non-ST-elevation acute coronary syndrome (NSTE-ACS) affects millions of patients. Although an invasive strategy can improve survival, the optimal treatment [i.e., percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG)] is not clear. We performed a meta-analysis of studies reporting outcomes between PCI and CABG in patients with NSTE-ACS. MEDLINE, EMBASE and Cochrane Library were assessed. The primary outcome was long-term mortality. Inverse variance method and random model were performed. We identified 13 observational studies (48,891 patients). No significant difference was found in the primary endpoint [CABG vs. PCI, incidence rate ratio (IRR) 0.93, 95% confidence interval (CI) 0.70; 1.23]. CABG was associated with lower long-term major adverse cardiovascular events (MACE) (IRR 0.64, 95% CI 0.54; 0.76) and lower long-term re-revascularization (IRR 0.37, 95% CI 0.30; 0.47). There was no significant difference in long-term myocardial infarction (CABG vs. PCI, IRR 0.96, 95% CI 0.50; 1.84) and peri-operative mortality (CABG vs. PCI, odds ratio 1.36, 95% CI 0.94; 1.95). For the treatment of NSTE-ACS, CABG and PCI are associated with similar rates of long-term mortality and myocardial infarction. CABG is associated with lower rates of long-term MACE and re-revascularization. Randomized comparisons in this setting are necessary.

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“…Otherwise, this trial illustrated decreased median values of time to procedure, procedure duration, and length of hospital stay. Although this trial included a total of 1,500 patients, it was only conducted for 1 year and it has never been researched before [14].…”

Section: Discussionmentioning

confidence: 99%

“…Recently, Rioufol et al published the RCT FUTURE study that compared FFR-guided vs angiographic-guided in patients that received PCI or CABG. They showed that the FFR-guided arm did not result in a decreased risk of ischemic cardiovascular events, but did decrease the revascularization rates [14]. Of note, the initial RCTs included patients who exclusively received PCI [9,11] or CABG [10,12].…”

Section: Discussionmentioning

confidence: 99%

Updated Meta-Analysis Comparing FFR-Guided and Angiographic-Guided Intervention in Patients with Multivessel Coronary Artery Disease

2022

IJHVS

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A new method to guide Percutaneous Coronary Interventions (PCI) and Coronary Artery Bypass Graft (CABG) interventions are by FFR, which is a measurement of the hemodynamic significance of coronary stenosis. We conducted an updated meta-analysis of all randomized controlled trials from inception to 5 December 2021 to compare studies that included patients who underwent FFR-guided PCI or CABG. The statistical analysis was performed using a random effect model to Calculate Risk Ratios (RR) and Mean Difference (MD) with 95% Confidence Intervals (CI). Five RCTs were included with a total of 2,288 patients and a median weighted follow-up period of 16.6 months. In this meta-analysis with a small sample size, there was no difference between FFR-guided and angiographicguided interventions for the rates of MACE and all-cause mortality. Moreover, the analysis showed that FFR-guided was associated with insignificantly decreased rates of MI (RR 0.77, 95% CI 0.51-1.16, p=0.21, I2=18%) and the number of revascularizations (RR 0.82, 95% CI 0.64-1.06, p=0.12, I2=0%). Finally, the average number of stents used per patient significantly favored the FFR-guided group (MD -0.16, 95% CI -0.24 to -0.07, p=0.0003, I2=93%). In conclusion, although FFR-guided did not have any benefit in decreasing MACE or allcause mortality, it was associated with improved outcomes of MI, the number of revascularizations, and the average number of stents.

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Fractional Flow Reserve–Guided PCI as Compared with Coronary Bypass Surgery

Cited by 212 publications

References 19 publications

Physiologic Lesion Assessment to Optimize Multivessel Disease

Physiologic Lesion Assessment to Optimize Multivessel Disease

A systematic review and meta-analysis of percutaneous coronary intervention compared to coronary artery bypass grafting in non-ST-elevation acute coronary syndrome

Updated Meta-Analysis Comparing FFR-Guided and Angiographic-Guided Intervention in Patients with Multivessel Coronary Artery Disease

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