We are well aware of the benefits of Fractional Flow Reserve (FFR) to assess coronary artery stenosis. FFR after PCI (post-PCI FFR) has been shown to have prognostic value; however, few studies have included patients with complex three-vessel disease. The impact of intravascular ultrasound (IVUS) or optical computer tomography (OCT) in this field has been even more overlooked.
The aim of this multicenter randomized study was to assess the prognostic value of post PCI FFR and intravascular imaging in patients undergoing PCI for three vessel disease in the FAME 3.
Primary end point was target vessel failure (TVF), a combination of cardiovascular death, treated vessel MI (TVMI) and target vessel revascularization (TVR) at 1 year.
Of 1500 patients included in the FAME 3 trial, 757 were randomized to FFR guided PCI. Of these, 61% were measured with FFR after PCI, and 15% had three-vessel disease. The artery most frequently assessed was the anterior descending, followed by the right coronary. Mean FFR value was 0.89. 9.1% had post PCI FFR 0.8 or lower. Post PCI FFR in the anterior descending artery was 0.87, while mean post PCI FFR in any other artery was 0.92.
Post PCI FFR value was a significant predictor of TVF at 1 year (HR=0.67 [95% CI: 0.48-0.93]. There was a significant and progressive reduction of TVF according to post PCI FFR values.
As regard IVUS imaging, there were no differences in cardiovascular death rate, AMI or the need for repeat revascularization vs. patients with no IVUS imaging.
Post PCI FFR was an independent predictor of TVF in patients with three-vessel disease. The use of IVUS had no effect on the assessed outcomes.
Dr. Andrés Rodríguez.
Member of the Editorial Board of SOLACI.org.
Original Title: Prognostic Value of Measuring Fractional Flow Reserve after Percutaneous Coronary Intervention in Patients with Complex Coronary Artery Disease: Insights from the FAME 3 Trial.
Reference: Zsolt Piroth, MD, PhD et al.
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