Fractional flow reserve versus angiography for guiding percutaneous coronary intervention.
Details
Serval ID
serval:BIB_524A4FFCC5C9
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Fractional flow reserve versus angiography for guiding percutaneous coronary intervention.
Journal
The New England journal of medicine
Working group(s)
FAME Study Investigators
Contributor(s)
Pijls N., Fearon W., De Bruyne B., Tonino P., Pijls N., Fearon W., De Bruyne B., Siebert U., Tonino P., Eeckhout E., El Gamal M., Barbato E., Kern M., Hodgson J., Siebert U., Gothe R., Bornschein B., Fearon W., Ikeno F., Brinton T., Lee D., Williams S., Yeung A., Ver Lee P., Wiseman A., Crespo G., Fincke R., Vom Eigen P., Lim M., Longnecker R., Leesar M., Yalamanchili V., Ikram S., Ragosta M., Gimple L., Lipson L., Powers E., Oldroyd K., Lindsay M., Robb S., Watkins S., Manoharan G., Tierney P., MacCarthy P., Shah A., Thomas M., Hill J., Baumbach A., Wilde P., Nightingale A., Skyme-Jones A., Barnes E., Herzfeld I., Törnerud M., Alström P., Witt N., Schersten F., Bonnier J., Botman C., Brueren B., van Dantzig J., Koolen J., Michels H., Peels C., Pijls N., Tonino P., Klauss V., Rieber J., Schiele T., Leibig M., Sohn Y., Söllner J., Bojara W., Lindstaedt M., Yazar A., Riess G., Werner G., Engstrøm T., Kelbaek H., Jørgensen E., Helqvist S., Saunamäki K., Clemmensen P., Kastrup J., Rasmussen K., Frobert O., De Bruyne B., Melikian N., Bartunek J., Wyffels E., Heyndrickx G., Wijns W., Vanderheyden M., Batjoens H.
ISSN
1533-4406 (Electronic)
ISSN-L
0028-4793
Publication state
Published
Issued date
15/01/2009
Peer-reviewed
Oui
Volume
360
Number
3
Pages
213-224
Language
english
Notes
Publication types: Comparative Study ; Journal Article ; Multicenter Study ; Randomized Controlled Trial ; Research Support, Non-U.S. Gov't
Publication Status: ppublish
Publication Status: ppublish
Abstract
In patients with multivessel coronary artery disease who are undergoing percutaneous coronary intervention (PCI), coronary angiography is the standard method for guiding the placement of the stent. It is unclear whether routine measurement of fractional flow reserve (FFR; the ratio of maximal blood flow in a stenotic artery to normal maximal flow), in addition to angiography, improves outcomes.
In 20 medical centers in the United States and Europe, we randomly assigned 1005 patients with multivessel coronary artery disease to undergo PCI with implantation of drug-eluting stents guided by angiography alone or guided by FFR measurements in addition to angiography. Before randomization, lesions requiring PCI were identified on the basis of their angiographic appearance. Patients assigned to angiography-guided PCI underwent stenting of all indicated lesions, whereas those assigned to FFR-guided PCI underwent stenting of indicated lesions only if the FFR was 0.80 or less. The primary end point was the rate of death, nonfatal myocardial infarction, and repeat revascularization at 1 year.
The mean (+/-SD) number of indicated lesions per patient was 2.7+/-0.9 in the angiography group and 2.8+/-1.0 in the FFR group (P=0.34). The number of stents used per patient was 2.7+/-1.2 and 1.9+/-1.3, respectively (P<0.001). The 1-year event rate was 18.3% (91 patients) in the angiography group and 13.2% (67 patients) in the FFR group (P=0.02). Seventy-eight percent of the patients in the angiography group were free from angina at 1 year, as compared with 81% of patients in the FFR group (P=0.20).
Routine measurement of FFR in patients with multivessel coronary artery disease who are undergoing PCI with drug-eluting stents significantly reduces the rate of the composite end point of death, nonfatal myocardial infarction, and repeat revascularization at 1 year. (ClinicalTrials.gov number, NCT00267774.)
In 20 medical centers in the United States and Europe, we randomly assigned 1005 patients with multivessel coronary artery disease to undergo PCI with implantation of drug-eluting stents guided by angiography alone or guided by FFR measurements in addition to angiography. Before randomization, lesions requiring PCI were identified on the basis of their angiographic appearance. Patients assigned to angiography-guided PCI underwent stenting of all indicated lesions, whereas those assigned to FFR-guided PCI underwent stenting of indicated lesions only if the FFR was 0.80 or less. The primary end point was the rate of death, nonfatal myocardial infarction, and repeat revascularization at 1 year.
The mean (+/-SD) number of indicated lesions per patient was 2.7+/-0.9 in the angiography group and 2.8+/-1.0 in the FFR group (P=0.34). The number of stents used per patient was 2.7+/-1.2 and 1.9+/-1.3, respectively (P<0.001). The 1-year event rate was 18.3% (91 patients) in the angiography group and 13.2% (67 patients) in the FFR group (P=0.02). Seventy-eight percent of the patients in the angiography group were free from angina at 1 year, as compared with 81% of patients in the FFR group (P=0.20).
Routine measurement of FFR in patients with multivessel coronary artery disease who are undergoing PCI with drug-eluting stents significantly reduces the rate of the composite end point of death, nonfatal myocardial infarction, and repeat revascularization at 1 year. (ClinicalTrials.gov number, NCT00267774.)
Keywords
Aged, Angioplasty, Balloon, Coronary/economics, Angioplasty, Balloon, Coronary/methods, Coronary Angiography/economics, Coronary Artery Disease/diagnostic imaging, Coronary Artery Disease/mortality, Coronary Artery Disease/therapy, Coronary Restenosis/prevention & control, Drug-Eluting Stents, Female, Follow-Up Studies, Fractional Flow Reserve, Myocardial, Health Care Costs, Humans, Kaplan-Meier Estimate, Length of Stay, Male, Middle Aged, Myocardial Infarction/epidemiology, Retreatment/statistics & numerical data, Stents
Pubmed
Web of science
Open Access
Yes
Create date
15/02/2010 14:41
Last modification date
09/03/2024 8:10
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