FFR-guided PCI in multivessel disease: a close match, or an underpowered verdict on CABG?

Area of Science:

• Cardiology
• Interventional Cardiology
• Cardiac Surgery

Background:

• The FAME 3 trial compared percutaneous coronary intervention (PCI) and coronary artery bypass graft surgery (CABG) for multivessel coronary artery disease.
• Long-term outcomes are crucial for guiding treatment decisions in complex coronary artery disease.

Purpose of the Study:

• To critically examine the 5-year clinical outcomes of the FAME 3 trial.
• To compare the efficacy and safety of FFR-guided PCI versus CABG in patients with multivessel coronary artery disease.

Main Methods:

• Analysis of the 5-year follow-up data from the FAME 3 randomized controlled trial.
• Comparison of a composite outcome (death, stroke, myocardial infarction) and individual components between PCI and CABG groups.

Main Results:

• No significant difference in the composite outcome of death, stroke, or myocardial infarction at 5 years between PCI and CABG.
• Higher rates of myocardial infarction and repeat revascularization were observed in the PCI group compared to the CABG group.
• Coronary artery bypass graft surgery showed greater benefit in patients with more complex coronary lesions.

Conclusions:

• While the composite endpoint was similar, PCI was associated with increased risks of myocardial infarction and repeat procedures at 5 years.
• CABG may offer greater long-term benefits, particularly for patients with complex coronary artery disease.
• Long-term follow-up is essential for a comprehensive understanding of treatment differences in multivessel coronary artery disease.