European Society of Cardiology
European Society of Cardiology
Perspective from Anthony A. Bavry, MD, MPH
September 02, 2014
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FAME II: FFR-guided PCI improves 2-year outcomes in stable CAD

Perspective from Anthony A. Bavry, MD, MPH
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BARCELONA, Spain — Compared with medical therapy alone, patients with stable CAD who also received fractional flow reserve-guided PCI experienced a reduction in the composite endpoint of all-cause death, nonfatal MI or urgent revascularization at 2 years. This difference was mainly driven by lower rates of urgent revascularization, according to new data from the FAME II trial.

“In patients with stable CAD, PCI is superior to medical therapy provided FFR is used to guide the procedure and [second-generation] DES are implanted,” Bernard De Bruyne, MD, PhD, FAME II investigator, said during a press conference.

As reported previously, the 7-month results of FAME II were presented by De Bruyne, of the Cardiovascular Center Aalst, Onze Lieve Vrouw Ziekenhuis, Aalst, Belgium, at ESC Congress 2012. For the new analysis, De Bruyne and colleagues looked at the 2-year outcomes of FFR-guided PCI with new-generation drug-eluting stents plus medical therapy (n=447) or medical therapy alone (n=441) in patients with stable CAD.

Bernard De Bruyne, MD, PhD

Bernard De Bruyne

An additional 332 patients with an FFR >0.8 were enrolled in a registry and treated with medical therapy. “There was a very high [rate of] compliance in [these] patients, which is at odds with clinical practice,” De Bruyne said, adding that it is important to realize that there are discrepancies between real-world practice and clinical studies.

FFR-guided PCI consisted of the use of the PressureWire Certus or PressureWire Aeris FFR measurement systems (St. Jude Medical). In one-quarter of patients scheduled for PCI, there were no hemodynamically significant stenosis, De Bruyne said.

The primary composite endpoint — all-cause death, nonfatal MI or urgent revascularization at 2 years — was significantly lower in patients in the FFR-guided PCI cohort (8.1% vs. 19.5%; HR=0.39; 95% CI, 0.26-0.57; P<.001), which was driven primarily by the lower rate of urgent revascularization in the PCI group (4% vs. 16.3%; HR=0.23; 95% CI, 0.14-0.38; P<.001). There were no significant differences between groups in the rates of death or MI.

Moreover, urgent revascularization triggered by MI or ischemic changes occurred less often in the FFR-guided PCI cohort (3.4% vs. 7%; P=.01).

Landmark analysis data also revealed a lower rate of death or MI from 8 days to 2 years in the FFR-guided PCI group (4.6% vs. 8%; P=.04).

In addition, De Bruyne said that patients in whom the stenosis are not able to induce ischemia (FFR >0.8) do well with medical therapy alone. – by Brian Ellis

For more information:

De Bruyne B. Hot Line IV: Myocardial Infarction. Presented at: the European Society of Cardiology Congress; Aug. 30-Sept. 3, 2014; Barcelona, Spain.

De Bruyne B. N Engl J Med. 2014;doi:10.1056/nejmoa1408758.

Disclosure: The study was supported by St. Jude Medical. De Bruyne reports that his institution receives grant support and consulting fees on his behalf from St. Jude Medical.