Earlier studies comparing percutaneous coronary intervention (PCI) vs coronary artery bypass graft (CABG) have shown fewer events at long term for the surgical strategy.
However, we should consider both percutaneous and surgical techniques have experienced advances, as has baseline optimal medical treatment (OMT).
The FAME 3 compared FFR guided PCI with contemporary stents against CABG, in patients with low OMT. Preliminary results at one year failed to show non-inferiority for PCI.
Clinical primary end point 5 year outcomes have been presented, a composite of mortality, stroke or acute MI. The study included patients with three-vessel coronary artery disease (3V-CAD) with no left main compromise from 48 centers across Europe, North America, Australia and Asia.
757 patients were included, mean age 65±8. 81% were men, 28% diabetic, and 40% presented acute coronary syndrome. Mean syntax score was 26, and most were intermediate cases (50%), with 12% use of intravascular imaging. Among CABG patients, 25% received arterial grafts and 24% underwent off-pump surgery.
There were no significant differences in primary end point at 5 years (16% vs 14%, HR 1.16, CI 95% 0.89-1.52; P=0.27). Landmark curve comparison analysis for the composite end point did not show a clear benefit of CABG vs PCI (HR 0.99, CI 95% 0.69-1.41).
Conclusión
At 5 years, three-vessel revascularization with FFR-PCI or CABG did not show significant differences for the combined end point of mortality, stroke or AMI.
Presented by William F. Fearon en Late-Breaking Clinical Trials, ACC 25, march 30, Chicago, EE.UU.
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