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Previous Volume 360:213-224 January 15, 2009 Number 3 Next

	Full Text PDF PDA Full Text PowerPoint Slide Set CME Exam Editorial by Ellis, S. G. Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited E-mail When Letters Appear PubMed Citation

ABSTRACT

Background In patients with multivessel coronary artery disease who are undergoing percutaneous coronary intervention (PCI), coronary angiography is the standard method for guiding the placement of the stent. It is unclear whether routine measurement of fractional flow reserve (FFR; the ratio of maximal blood flow in a stenotic artery to normal maximal flow), in addition to angiography, improves outcomes.

Methods In 20 medical centers in the United States and Europe, we randomly assigned 1005 patients with multivessel coronary artery disease to undergo PCI with implantation of drug-eluting stents guided by angiography alone or guided by FFR measurements in addition to angiography. Before randomization, lesions requiring PCI were identified on the basis of their angiographic appearance. Patients assigned to angiography-guided PCI underwent stenting of all indicated lesions, whereas those assigned to FFR-guided PCI underwent stenting of indicated lesions only if the FFR was 0.80 or less. The primary end point was the rate of death, nonfatal myocardial infarction, and repeat revascularization at 1 year.

Results The mean (±SD) number of indicated lesions per patient was 2.7±0.9 in the angiography group and 2.8±1.0 in the FFR group (P=0.34). The number of stents used per patient was 2.7±1.2 and 1.9±1.3, respectively (P<0.001). The 1-year event rate was 18.3% (91 patients) in the angiography group and 13.2% (67 patients) in the FFR group (P=0.02). Seventy-eight percent of the patients in the angiography group were free from angina at 1 year, as compared with 81% of patients in the FFR group (P=0.20).

Conclusions Routine measurement of FFR in patients with multivessel coronary artery disease who are undergoing PCI with drug-eluting stents significantly reduces the rate of the composite end point of death, nonfatal myocardial infarction, and repeat revascularization at 1 year. (ClinicalTrials.gov number, NCT00267774 [ClinicalTrials.gov] .)

Source Information

From the Catharina Hospital, Eindhoven, the Netherlands (P.A.L.T., N.H.J.P., M.V.); Cardiovascular Center Aalst, Aalst, Belgium (B.D.B.); University of Health Sciences, Medical Informatics, and Technology, Hall in Tirol, Austria, and Massachusetts General Hospital, Harvard Medical School, Boston (U.S.); Stanford University Medical Center and Palo Alto Veterans Affairs Health Care Systems, Stanford, CA (F.I., W.F.F.); Medizinische Poliklinik, Campus-Innenstadt, University Hospital, Munich, Germany (V.K.); the Heart Centre, Royal Victoria Hospital, Belfast, United Kingdom (G.M.); Rigshopitalet, Copenhagen (T.E.); Western Infirmary, Glasgow, United Kingdom (K.G.O.); Northeast Cardiology Associates, Bangor, ME (P.N.V.L.); and King's College Hospital, London (P.A.M.).

Address reprint requests to Dr. Pijls at the Department of Cardiology, Catharina Hospital, Michelangelolaan 2, 5623 EJ, Eindhoven, the Netherlands, or at nico.pijls{at}inter.nl.net.

Full Text of this Article

Related Letters:

Fractional Flow Reserve for Guiding PCI
Brar S. S., Gray W. A., Nagajothi N., Arora R., Khosla S., Garg S., Rademaker T., Serruys P., Pijls N. H.J., Tonino P. A.L., Fearon W. F., the FAME Investigators
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N Engl J Med 2009; 360:2024-2027, May 7, 2009. Correspondence

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