Fractional Flow Reserve-Guided PCI or Coronary Bypass Surgery for 3-Vessel Coronary Artery Disease: 3-Year Follow-Up...

Area of Science:

• Cardiology
• Interventional Cardiology
• Clinical Trials

Background:

• Previous studies suggest coronary artery bypass grafting (CABG) has lower rates of death, myocardial infarction (MI), or stroke than percutaneous coronary intervention (PCI) for multivessel coronary disease.
• Older studies did not routinely use current-generation drug-eluting stents or fractional flow reserve (FFR) to guide PCI, potentially influencing outcomes.

Purpose of the Study:

• To compare the 3-year incidence of death, MI, or stroke between FFR-guided PCI with drug-eluting stents and CABG in patients with 3-vessel coronary artery disease not involving the left main artery.

Main Methods:

• The FAME 3 trial randomized 1500 patients with 3-vessel coronary artery disease to either FFR-guided PCI using zotarolimus drug-eluting stents or CABG.
• Follow-up was achieved in over 96% of patients in both groups.

Main Results:

• There was no significant difference in the composite of death, MI, or stroke at 3 years between FFR-guided PCI and CABG (12.0% vs. 9.2%; P=0.07).
• Rates of death and stroke were similar between the two groups.
• Myocardial infarction occurred more frequently after PCI compared to CABG (7.0% vs. 4.2%; P=0.02).

Conclusions:

• FFR-guided PCI with current-generation drug-eluting stents demonstrated comparable rates of death, MI, or stroke to CABG at 3-year follow-up.
• A higher incidence of MI was observed after PCI, while death and stroke rates were similar.
• These findings support shared decision-making for patients with 3-vessel coronary artery disease.