TY - JOUR
T1 - Outcomes Based on Angiographic vs Functional Significance of Complex 3-Vessel Coronary Disease
T2 - FAME 3 Trial
AU - FAME 3 Trial Investigators
AU - Kobayashi, Yuhei
AU - Takahashi, Tatsunori
AU - Zimmermann, Frederik M.
AU - Otsuki, Hisao
AU - El Farissi, Mohamed
AU - Oldroyd, Keith G.
AU - Wendler, Olaf
AU - Reardon, Michael J.
AU - Woo, Y. Joseph
AU - Yeung, Alan C.
AU - De Bruyne, Bernard
AU - Pijls, Nico H.J.
AU - Fearon, William F.
N1 - Copyright © 2023 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
PY - 2023/9/11
Y1 - 2023/9/11
N2 - Background: The functional SYNTAX score (FSS), which incorporates functional information as assessed by fractional flow reserve (FFR), is a better predictor of outcome after percutaneous coronary intervention (PCI) in patients with less complex coronary artery disease (CAD). Objectives: This study sought to test the prognostic value of the FSS in patients with complex CAD eligible for coronary artery bypass grafting (CABG). Methods: The FAME 3 (Fractional Flow Reserve Versus Angiography for Multivessel Evaluation 3) trial compared FFR-guided PCI with CABG in patients with angiographic 3-vessel CAD. In this prespecified substudy, the angiographic core laboratory calculated the SYNTAX score (SS) and then the FSS by eliminating lesions that were not significant based on FFR. Outcomes in the PCI patients based on the FSS and the SS were compared to each other and to the patients treated with CABG. Results: The FSS reclassified more than one-quarter of patients from an SS >22 to an FSS ≤22. In the 50% of PCI patients who had an FSS ≤22, the primary endpoint occurred at a similar rate to patients treated with CABG (P = 0.77). The primary endpoint in patients without functionally significant 3-vessel CAD was similar to the CABG group (P = 0.97). The rate of myocardial infarction and revascularization among all deferred lesions was 0.5% and 3.2%, respectively. Conclusions: By measuring the FSS, one can identify 50% of patients who have a similar outcome at 1 year with PCI compared with CABG. Lesions deferred from PCI based on FFR have a low event rate.
AB - Background: The functional SYNTAX score (FSS), which incorporates functional information as assessed by fractional flow reserve (FFR), is a better predictor of outcome after percutaneous coronary intervention (PCI) in patients with less complex coronary artery disease (CAD). Objectives: This study sought to test the prognostic value of the FSS in patients with complex CAD eligible for coronary artery bypass grafting (CABG). Methods: The FAME 3 (Fractional Flow Reserve Versus Angiography for Multivessel Evaluation 3) trial compared FFR-guided PCI with CABG in patients with angiographic 3-vessel CAD. In this prespecified substudy, the angiographic core laboratory calculated the SYNTAX score (SS) and then the FSS by eliminating lesions that were not significant based on FFR. Outcomes in the PCI patients based on the FSS and the SS were compared to each other and to the patients treated with CABG. Results: The FSS reclassified more than one-quarter of patients from an SS >22 to an FSS ≤22. In the 50% of PCI patients who had an FSS ≤22, the primary endpoint occurred at a similar rate to patients treated with CABG (P = 0.77). The primary endpoint in patients without functionally significant 3-vessel CAD was similar to the CABG group (P = 0.97). The rate of myocardial infarction and revascularization among all deferred lesions was 0.5% and 3.2%, respectively. Conclusions: By measuring the FSS, one can identify 50% of patients who have a similar outcome at 1 year with PCI compared with CABG. Lesions deferred from PCI based on FFR have a low event rate.
KW - 3-vessel disease
KW - fractional flow reserve
KW - functional SYNTAX score
KW - Coronary Artery Disease/diagnostic imaging
KW - Percutaneous Coronary Intervention/adverse effects
KW - Fractional Flow Reserve, Myocardial
KW - Angiography
KW - Vascular Diseases
KW - Humans
KW - Treatment Outcome
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U2 - 10.1016/j.jcin.2023.06.023
DO - 10.1016/j.jcin.2023.06.023
M3 - Article
C2 - 37704297
AN - SCOPUS:85169023636
SN - 1936-8798
VL - 16
SP - 2112
EP - 2119
JO - JACC: Cardiovascular Interventions
JF - JACC: Cardiovascular Interventions
IS - 17
ER -