Patients and Healthcare Providers Benefit from Less Symptoms and Lower Costs with FFR

Previous studies in which revascularization was guided by angiography alone found that coronary angioplasty does not improve outcomes compared with optimal medical treatment in patients with chronic stable angina. The FAME 2 trial (Fractional Flow Reserve Versus Angiography for Multivessel Evaluation) compared angioplasty guided by fractional flow reserve (FFR) with optimal medical treatment, arriving to conclusions in terms of both clinical outcomes and cost-effectiveness.

A total of 888 patients with stable chronic angina and single-vessel or multivessel lesions with reduced fractional flow reserve were randomly assigned to angioplasty plus optimal medical treatment (n = 447) or optimal medical treatment alone (n = 441). The primary endpoint was a composite of major cardiac events including death, acute myocardial infarction, and urgent revascularization.

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The combined endpoint at 3 years was significantly lower in the FFR-guided angioplasty group compared with the medical treatment group (10.1% vs. 22.0%; p < 0.001), mainly as a result of lower rates of urgent revascularization.

Death and infarction were numerically lower in the angioplasty group, but the difference was not statistically significant (8.3% vs. 10.4%; p = 0.28). Angina frequency and severity at 3 years were also lower among patients in the angioplasty arm.

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Initially, angioplasty costs doubled those derived from medical treatment; however, over time, costs became equal due to urgent revascularizations and adjustments for quality of life.

Conclusion

FFR-guided angioplasty in stable patients reduces events at 3 years and is economically attractive compared with medical treatment alone.

Editorial

No differences in costs were observed among groups after a 3-year follow-up, and less patients in the angioplasty arm presented angina. This difference as regards angina persisted over the whole follow-up period, which could be explained by the low number of patients in the medical treatment arm that were scheduled to cross over to undergo angioplasty. Finally, symptoms forced urgent revascularizations that ultimately tilted the scales in favor of angioplasty.

Original title: Clinical Outcomes and Cost-Effectiveness of Fractional Flow Reserve–Guided Percutaneous Coronary Intervention in Patients With Stable Coronary Artery Disease. Three-Year Follow-Up of the FAME 2 Trial (Fractional Flow Reserve Versus Angiography for Multivessel Evaluation).

Reference: William F. Fearon et al. Circulation. 2017;136:00-00.

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