FAME 2: Reshaping the approach to patients with stable coronary artery disease

Area of Science:

• Cardiology
• Interventional Cardiology
• Ischemic Heart Disease

Background:

• Percutaneous coronary intervention (PCI) is standard for acute coronary syndromes but limited in stable ischemic heart disease (SIHD).
• Previous studies like COURAGE showed no mortality or myocardial infarction benefit of PCI over optimal medical therapy (OMT) in SIHD.
• Limitations in prior studies included imprecise visual assessment of coronary stenoses and potential inaccuracies in non-invasive stress testing.

Purpose of the Study:

• To investigate if PCI guided by fractional flow reserve (FFR) improves outcomes in SIHD patients compared to OMT alone.
• To address limitations of previous studies by using FFR to accurately identify functionally significant coronary lesions.

Main Methods:

• The FAME 2 trial compared FFR-guided PCI plus OMT versus OMT alone in patients with SIHD.
• Fractional flow reserve (FFR) was used to determine the functional significance of coronary artery stenoses.

Main Results:

• FFR-guided PCI plus OMT was superior to OMT alone in reducing the composite endpoint of death, myocardial infarction, or urgent revascularization.
• This suggests that accurately identifying and treating functionally significant lesions with PCI improves outcomes in SIHD.

Conclusions:

• FFR-guided PCI offers a significant benefit over OMT alone for patients with SIHD.
• Accurate lesion selection using FFR is crucial for optimizing PCI outcomes in stable ischemic heart disease.