Journal Club - FAME 3 Subanalysis Adds Twist to Negative Primary Results - Video

Published On 2022-05-04T18:39:12+05:30 | Updated On 4 May 2022 6:39 PM IST

Overview

Ischemic heart disease is the leading cause of death globally. Coronary artery bypass graft (CABG) surgery and percutaneous coronary intervention (PCI) are the two revascularization options for ischemic heart disease. However, the choice of the most appropriate revascularization modality is controversial and has been an issue of debate.

choice of revascularization and the status of percutaneous coronary intervention ie PCI in treating coronary artery disease. Previously in the FAME 2 trial the researchers concluded that in patients with stable coronary artery disease and functionally significant stenoses, FFR-guided PCI plus the best available medical therapy, as compared with the best available medical therapy alone, decreased the need for urgent revascularization. In patients without ischemia, the outcome appeared to be favorable with the best available medical therapy alone.

And the FAME 3 triAl showed that In patients with three-vessel coronary artery disease, FFR-guided PCI was not found to be noninferior to CABG with respect to the incidence of a composite of death, myocardial infarction, stroke, or repeat revascularization at 1 year.

But a new sub analysis of the FAME 3 trial has failed to show that percutaneous intervention (PCI) guided by fractional flow reserve (FFR) is non inferior to coronary artery bypass grafting (CABG) for treating three-vessel coronary artery disease. This has associated PCI with early quality of life (QOL) advantages, despite a modestly greater risk of major adverse cardiac events (MACE) at the end of 12 months' follow-up among those treated with FFR-guided PCI.

This is in accordance to the findings presented at the annual scientific sessions of the American College of Cardiology by Dr. Frederik M. Zimmerman, MD, of Catharina Hospital in the Netherlands.

The primary results of FAME 3 were presented at the 2021 Transcatheter Cardiovascular Therapeutics annual meeting and published simultaneously in the New England Journal of Medicine. Rather than confirming the hypothesis that fractional flow reserve -guided PCI is comparable with CABG for the primary composite, myocardial infarction, stroke, or revascularization, the incidence of MACE at 12 months was 10.6% in those randomized to PCI and 6.9% in the group assigned to CABG. which was significant.

Ultimately, the study did not show differences in any of these measures at the end of 12 months, but there were significant differences in QOL and employment at earlier time points. Hence, the researchers concluded that these results suggest that thought there are more MACE with FFR- guided PCI yet the potentially clinically meaningful early advantages for fractional flow reserve - guided PCI exist.

Speakers

Dr. Nandita Mohan

BDS, MDS( Pedodontics and Preventive Dentistry)

Dr. Nandita Mohan is a practicing pediatric dentist with more than 5 years of clinical work experience. Along with this, she is equally interested in keeping herself up to date about the latest developments in the field of medicine and dentistry which is the driving force for her to be in association with Medical Dialogues. She also has her name attached with many publications; both national and international. She has pursued her BDS from Rajiv Gandhi University of Health Sciences, Bangalore and later went to enter her dream specialty (MDS) in the Department of Pedodontics and Preventive Dentistry from Pt. B.D. Sharma University of Health Sciences. Through all the years of experience, her core interest in learning something new has never stopped. She can be contacted at editorial@medicaldialogues.in. Contact no. 011-43720751