Fractional flow reserve-guided percutaneous coronary intervention vs. medical therapy for patients with stable coronary lesions: meta-analysis of individual patient data

Abstract

AimsTo assess the effect of fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI) with contemporary drug-eluting stents on the composite of cardiac death or myocardial infarction (MI) vs. medical therapy in patients with stable coronary lesions.Methods and resultsWe performed a systematic review and meta-analysis of individual patient data (IPD) of the three available randomized trials of contemporary FFR-guided PCI vs. medical therapy for patients with stable coronary lesions: FAME 2 (NCT01132495), DANAMI-3-PRIMULTI (NCT01960933), and Compare-Acute (NCT01399736). FAME 2 enrolled patients with stable coronary artery disease (CAD), while the other two focused on non-culprit lesions in stabilized patients after acute coronary syndrome. A total of 2400 subjects were recruited from 54 sites world-wide with 1056 randomly assigned to FFR-guided PCI and 1344 to medical therapy. The pre-specified primary outcome was a composite of cardiac death or MI. We included data from extended follow-ups for FAME 2 (up to 5.5 years follow-up) and DANAMI-3-PRIMULTI (up to 4.7 years follow-up). After a median follow-up of 35 months (interquartile range 12–60 months), a reduction in the composite of cardiac death or MI was observed with FFR-guided PCI as compared with medical therapy (hazard ratio 0.72, 95% confidence interval 0.54–0.96; P = 0.02). The difference between groups was driven by MI.ConclusionIn this IPD meta-analysis of the three available randomized controlled trials to date, FFR-guided PCI resulted in a reduction of the composite of cardiac death or MI compared with medical therapy, which was driven by a decreased risk of MI.

The Effect of Functional and Intra-Coronary Imaging Techniques on Fluoroscopy Time, Radiation Dose and Contrast Volume during Coronary Angiography

“…This study demonstrated that complementary studies explain only a small percentage of the radiation and contrast media variations when used in coronary angiography. There are many advantages to complementary studies such as decreasing mortality, guidance in stent placement, and better angiography outcomes 3,14 . Patients can avoid unnecessary stent placement.…”

Quantitative flow ratio virtual stenting and post stenting correlations to post stenting fractional flow reserve measurements from the DOCTORS (Does Optical Coherence Tomography Optimize Results of Stenting) study population

“…Fractional flow reserve (FFR) has become the invasive gold standard evaluation to assess the ischemic potential of a coronary artery stenosis and the anticipated clinical benefit from revascularization. [1][2][3][4][5][6] FFR links the physiological impact of a coronary stenosis to clinical outcome with a risk continuum. 7 Similarly, FFR has been used to quantify the results of percutaneous coronary intervention (PCI) and showed increasingly better clinical outcomes in patients with higher post-PCI FFR values.…”

SOP Pharmakotherapie des chronischen Koronarsyndroms

“…Die Relevanz der Stenose, erscheint sie angiografisch nicht eindeutig, sollte vorher durch eine koronarphysiologische Messung nachgewiesen werden [1]. Bisherige wissenschaftliche Erkenntnisse lassen darauf schließen, dass durch eine adäquate Revaskularisation sowohl Symptome als auch das Myokardinfarktrisiko der Patienten reduziert werden können [2].…”