For CAD, PCI Plus Medication Outperforms Standard Treatment

Fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI) plus medical therapy is associated with improved outcomes compared with medical therapy alone in patients with stable coronary artery disease, according to a new study.

For their study, the researchers evaluated 1220 patients with angiographically significant stenosis. Of these patients, those with at least 1 hemodynamically significant stenosis (n = 888)—defined as an FFR of 0.80 or less—were randomly assigned to FFR-guided PCI plus medical therapy (n = 447) or to medical therapy alone (n = 441).
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Medical therapy was initiated among patients in whom all stenoses had an FFR of more than 0.80, and these patients were entered into a registry. The primary endpoint included death, myocardial infarction, or urgent revascularization.

Results showed that PCI group experienced a lower rate of the primary endpoint compared with the medical therapy group at 5 years (13.9% vs 27.0%, respectively; hazard ratio [HR] 0.46).

The researchers noted that this difference was due to urgent revascularizations, which were required in 6.3% of PCI patients vs 21.1% of those who received medical therapy alone (HR 0.27).

In addition, relief from angina was more evident in the PCI group than in the group receiving medical therapy alone.

However, no significant between-group differences were observed in regard to rates of death (5.1% vs 5.2%; HR 0.98) or myocardial infarction (8.1% vs 12.0%; HR 0.66). Furthermore, no significant difference was observed in the rate of the primary end point between the PCI group and the registry cohort (13.9% and 15.7%, respectively; HR 0.88).

“In patients with stable coronary artery disease, an initial FFR-guided PCI strategy was associated with a significantly lower rate of the primary composite end point of death, myocardial infarction, or urgent revascularization at 5 years than medical therapy alone,” the researchers concluded. “Patients without hemodynamically significant stenoses had a favorable long-term outcome with medical therapy alone.”

—Christina Vogt

Reference:

Xaplanteris P, Fournier S, Pijls NHJ, et al; FAME 2 Investigators. Five-year outcomes with PCI guided by fractional flow reserve [Published online May 22, 2018]. N Eng J Med. doi:10.1056/NEJMoa1803538

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