3-vessel CAD outcomes comparable with fractional flow reserve-guided PCI vs CABG

In the treatment of patients with 3-vessel coronary artery disease (CAD), fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI) does not differ from coronary artery bypass grafting (CABG) in terms of the incidence of the composite of death, myocardial infarction (MI), or stroke, according to 3-year data from the FAME 3* trial.

FAME 3 included 1,500 patients (mean age 66 years, 29 percent had diabetes, 39 percent had acute coronary syndrome) with 3-vessel CAD (not involving the left main coronary artery) who had been randomly assigned to undergo FFR-guided PCI (n=757) using zotarolimus drug-eluting stents or CABG (n=743).

In the PCI group, 24 percent of the lesions intended for treatment had an FFR of >0.80. The mean number of drug-eluting stents implanted was 3.7. Meanwhile, in the CABG group, patients received a mean of 3.4 distal anastomoses. Adherence to guideline-directed medical therapy remained high throughout the trial, with 91 percent of patients receiving a statin at 3 years.

3-year follow-up data were available for >96 percent of patients in both groups. There was no difference in the main outcome of the incidence of the composite of death, MI, or stroke after FFR-guided PCI compared vs CABG (12.0 percent vs 9.2 percent; hazard ratio [HR], 1.3, 95 percent confidence interval [CI], 0.98–1.83; p=0.07).

Likewise, the PCI and CABG groups had similar rates of death (4.1 percent vs 3.9 percent vs; HR, 1.0, 95 percent CI, 0.6–1.7; p=0.88) and stroke (1.6 percent vs 2.0 percent; HR, 0.8, 95 percent CI, 0.4–1.7; p=0.56).

However, MI occurred more frequently in the PCI group (7.0 percent vs 4.2 percent; HR, 1.7, 95 percent CI, 1.1–2.7; p=0.02).

The findings may improve shared decision-making between physicians and patients with 3-vessel CAD.

*Fractional Flow Reserve versus Angiography for Multivessel Evaluation