View source for Measuring Fractional Flow Reserve During PCI Improves 1-Year Outcomes

'''January 26, 2009''' ''By Michael W Tempelhof, MD [mailto:tempe004@mc.duke.edu]''

[[Percutaneous coronary intervention]] ([[PCI]]) for treatment of [[NSTEMI]] and/or [[STEMI]] from [[ischemia]] has been associated with improvements in short-term and long-term clinical outcomes. However, in ischemic patients with multiple vessel disease, determination of which lesion is the culprit stenotic lesion requiring intervention is often difficult. 

[[Fractional Flow Reserve]] (FFR): is the ratio of maximal blood flow in a stenotic vessel to normal maximal flow.

STUDY OBJECTIVE: To investigate whether FFR-guided PCI would be associated with better outcomes (rates of major adverse cardiac events (MACE) at 1 year, [[death]], [[MI]], or repeat revascularization at 1 year) vs. routine [[angiography]]-guided [[PCI]] in ischemic patients with multivessel disease.

STUDY DESIGN and METHODS: 1005 Patients with stenoses of >50% in at least two of the three major [[coronary arteries]] where [[randomized]] to either routine [[PCI]], or [[FFR]]-guided [[PCI]], where [[FFR]] was measured in all significant stenoses, with stenting in lesions with an [[FFR]] ≤0.8.

RESULTS: Rates of MACE at 1 year was significantly lower in the [[FFR ]]arm compared with the routine-[[PCI]] arm (13.2% vs. 18.3%, p = 0.02). The incidence of [[death]] (1.8% vs. 3.0%, p = 0.19), [[myocardial infarction]] (MI) (5.7% vs. 8.7%, p = 0.07), and [[coronary artery bypass grafting]] or revascularization at year (6.5% vs. 9.5%, p = 0.08) was similar between both arms.

Mean procedure time was similar between the two study arms 70 minutes. Quantity of contrast dye utilized was significantly lower in the [[FFR]] arm, 272ml vs. 302 ml for standard [[PCI]] arm. The number of patients who were [[angina]] free at 1 year was also similar between the two arms (81% vs. 78%, p = 0.2). As measured by the EuroQOL-5D, the quality of life scores were similar between the two arms(p = 0.65).

CONCLUSIONS: The FAME trial results indicate that [[FFR]]-guided [[PCI]] is associated with a significantly lower incidence of MACE at year compared with routine [[angiography]]-guided [[PCI]] in [[ischemic]] patients with multivessel disease. [[FFR]]-guided [[PCI]] had a favorable cost-benefit ratio, similar procedural times to standard [[PCI]] and exposed patients to less contrast dye.

Tonino PA, De Bruyne B, Pijls NH, et al., on behalf of the FAME Investigators. Fractional flow reserve versus [[angiography]] for guiding [[percutaneous coronary intervention]].

===Source===
N Engl J Med. 2009 Jan 15;360(3):213-24.

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