Impact of a Chronic Total Occlusion on Outcomes After FFR-Guided PCI or Coronary Bypass Surgery: A FAME 3 Substudy.

Autor:	Otsuki H; Cardiovascular Medicine and Stanford Cardiovascular Institute, Stanford University, CA (H.O., K.T., A.C.Y., W.F.F.)., Takahashi K; Cardiovascular Medicine and Stanford Cardiovascular Institute, Stanford University, CA (H.O., K.T., A.C.Y., W.F.F.)., Zimmermann FM; Catharina Hospital, Eindhoven, the Netherlands (F.M.Z., N.H.J.P.).; St. Antonius Hospital, Nieuwegein, the Netherlands. (F.M.Z.)., Mavromatis K; Atlanta VA Healthcare System, Decatur, GA (K.M.).; Emory University School of Medicine, Atlanta, GA (K.M.)., Aminian A; Centre Hospitalier Universitaire de Charleroi, Belgium (A.A.)., Jagic N; Clinical Hospital Centre Zemun, University of Belgrade, Serbia (N.J.)., Dambrink JE; Isala Hospital, Zwolle, the Netherlands (J.-H.E.D.)., Kala P; University Hospital Brno and Masaryk University Brno, Bruno, Czech Republic (P.K.)., MacCarthy P; King's College Hospital, London, United Kingdom (P.M.)., Witt N; Karolinska Institute, Department of Clinical Science and Education, Division of Cardiology at Södersjukhuset, Stockholm, Sweden (N.W.)., Kobayashi Y; New York-Presbyterian Brooklyn Methodist Hospital, Weill Cornell Medical College, Brooklyn (Y.K.)., Takahashi T; Cedars-Sinai Medical Center, Los Angeles, CA (T.T.)., Woo YJ; Department of Cardiothoracic Surgery and Stanford Cardiovascular Institute, Stanford University, CA (Y.J.W.)., Yeung AC; Cardiovascular Medicine and Stanford Cardiovascular Institute, Stanford University, CA (H.O., K.T., A.C.Y., W.F.F.)., De Bruyne B; Cardiovascular Center Aalst, Belgium (B.D.B.)., Pijls NHJ; Catharina Hospital, Eindhoven, the Netherlands (F.M.Z., N.H.J.P.)., Fearon WF; Cardiovascular Medicine and Stanford Cardiovascular Institute, Stanford University, CA (H.O., K.T., A.C.Y., W.F.F.).; VA Palo Alto Health Care System, CA (W.F.F.).
Jazyk:	angličtina
Zdroj:	Circulation. Cardiovascular interventions [Circ Cardiovasc Interv] 2024 Nov; Vol. 17 (11), pp. e014300. Date of Electronic Publication: 2024 Nov 06.
DOI:	10.1161/CIRCINTERVENTIONS.124.014300
Abstrakt:	Background: The clinical impact of a chronic total occlusion (CTO) in patients with 3-vessel coronary artery disease undergoing fractional flow reserve-guided percutaneous coronary intervention (PCI) with current-generation drug-eluting stents or coronary artery bypass grafting (CABG) is unclear. Methods: The FAME 3 trial (Fractional Flow Reserve Versus Angiography for Multivessel Evaluation 3) compared fractional flow reserve-guided PCI with CABG in patients with 3-vessel coronary artery disease. The primary end point was major adverse cardiac and cerebrovascular events, a composite of death, myocardial infarction, stroke, or repeat revascularization at 1 year. In this substudy, the 3-year outcomes were analyzed in patients with or without a CTO. Results: Of the patients randomized to PCI or CABG in the FAME 3 trial, 305 (21%) had a CTO. In the PCI arm, revascularization of the CTO was attempted in 61% with a procedural success rate of 88%. The incidence of major adverse cardiac and cerebrovascular events at 3 years was not significantly different between those with or without a CTO in both the PCI (15.2% versus 20.1%; adjusted hazard ratio, 0.62 [95% CI, 0.38-1.03]; P =0.07) and the CABG (13.0% versus 12.9%; adjusted hazard ratio, 0.96 [95% CI, 0.55-1.66]; P =0.88) arms. In those without a CTO, PCI was associated with a significantly higher risk of major adverse cardiac and cerebrovascular events compared with CABG (adjusted hazard ratio, 1.61 [95% CI, 1.20-2.17]; P <0.01) but not in those with a CTO (adjusted hazard ratio, 1.21 [95% CI, 0.64-2.28]; P =0.56; P interaction =0.31). Conclusions: The presence of a CTO did not significantly impact the treatment effect of PCI versus CABG at 3 years in patients with 3-vessel coronary artery disease. Clinical Trial Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT02100722. Competing Interests: Dr Otsuki has received research grants from the Uehara Memorial Foundation, Abbott, Medtronic, Boston Scientific, and Terumo. Dr Fearon has received institutional research grants from Abbott Vascular and Medtronic, had a consulting relationship with CathWorks, and has stock options with HeartFlow. Dr Mavromatis reported that his institution (Atlanta Research Education Foundation) has received grant support from Stanford University. The other authors report no conflicts.
Databáze:	MEDLINE
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