Fractional flow reserve-guided PCI for stable coronary artery disease

Autor: De Bruyne B, Fearon WF, Pijls NH, Tonino P, Piroth Z, Jagic N, Mobius Winckler S, Rioufol G, Witt N, Kala P, MacCarthy P, Engstr?m T, Oldroyd K, Mavromatis K, Manoharan G, Verlee P, Frobert O, Curzen N, Johnson JB, Limacher A, N?esch E, J?ni P, FAME 2 Trial Investigators, BARBATO, EMANUELE
Přispěvatelé: Cardiovasculaire, métabolisme, diabétologie et nutrition (CarMeN), Institut National de la Recherche Agronomique (INRA)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM), Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Université de Lyon-Institut National des Sciences Appliquées (INSA)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Institut National de la Recherche Agronomique (INRA), De Bruyne, B, Fearon, Wf, Pijls, Nh, Barbato, Emanuele, Tonino, P, Piroth, Z, Jagic, N, Mobius Winckler, S, Rioufol, G, Witt, N, Kala, P, Maccarthy, P, Engstr?m, T, Oldroyd, K, Mavromatis, K, Manoharan, G, Verlee, P, Frobert, O, Curzen, N, Johnson, Jb, Limacher, A, N?esch, E, J?ni, P, Fame, 2 Trial Investigators, Cardiovascular Biomechanics
Jazyk: angličtina
Rok vydání: 2014
Předmět:
Coronary Disease/drug therapy/mortality/physiopathology/*therapy
medicine.medical_specialty
medicine.medical_treatment
Fractional Flow Reserve
[SDV]Life Sciences [q-bio]
610 Medicine & health
Fractional flow reserve
Kaplan-Meier Estimate
Revascularization
Coronary artery disease
360 Social problems & social services
Internal medicine
medicine
Myocardial Infarction/epidemiology/prevention & control
Humans
Myocardial
Myocardial infarction
Instantaneous wave-free ratio
Proportional Hazards Models
business.industry
Hazard ratio
Percutaneous coronary intervention
General Medicine
medicine.disease
Adrenergic beta-Antagonists/therapeutic use
Combined Modality Therapy
Angiotensin Receptor Antagonists/therapeutic use
3. Good health
Surgery
Angiotensin-Converting Enzyme Inhibitors/therapeutic use
Conventional PCI
Cardiology
Percutaneous Coronary Intervention/adverse effects/*methods
business
Zdroj: New England Journal of Medicine
New England Journal of Medicine, Massachusetts Medical Society, 2014, 371 (13), pp.1208-17. ⟨10.1056/NEJMoa1408758⟩
De Bruyne, Bernard; Fearon, William F; Pijls, Nico H J; Barbato, Emanuele; Tonino, Pim; Piroth, Zsolt; Jagic, Nikola; Mobius-Winckler, Sven; Riouffol, Gilles; Witt, Nils; Kala, Petr; MacCarthy, Philip; Engström, Thomas; Oldroyd, Keith; Mavromatis, Kreton; Manoharan, Ganesh; Verlee, Peter; Frobert, Ole; Curzen, Nick; Johnson, Jane B; ... (2014). Fractional Flow Reserve–Guided PCI for Stable Coronary Artery Disease. New England journal of medicine NEJM, 371(13), pp. 1208-1217. Massachusetts Medical Society MMS 10.1056/NEJMoa1408758
FAME 2 Trial Investigators 2014, ' Fractional flow reserve-guided PCI for stable coronary artery disease ', New England Journal of Medicine, vol. 371, no. 13, pp. 1208-1217 . https://doi.org/10.1056/NEJMoa1408758
The New England Journal of Medicine, 371(13), 1208-1217. Massachussetts Medical Society
ISSN: 0028-4793
1533-4406
DOI: 10.1056/NEJMoa1408758⟩
Popis: International audience; BACKGROUND: We hypothesized that in patients with stable coronary artery disease and stenosis, percutaneous coronary intervention (PCI) performed on the basis of the fractional flow reserve (FFR) would be superior to medical therapy. METHODS: In 1220 patients with stable coronary artery disease, we assessed the FFR in all stenoses that were visible on angiography. Patients who had at least one stenosis with an FFR of 0.80 or less were randomly assigned to undergo FFR-guided PCI plus medical therapy or to receive medical therapy alone. Patients in whom all stenoses had an FFR of more than 0.80 received medical therapy alone and were included in a registry. The primary end point was a composite of death from any cause, nonfatal myocardial infarction, or urgent revascularization within 2 years. RESULTS: The rate of the primary end point was significantly lower in the PCI group than in the medical-therapy group (8.1% vs. 19.5%; hazard ratio, 0.39; 95% confidence interval [CI], 0.26 to 0.57; P\textless0.001). This reduction was driven by a lower rate of urgent revascularization in the PCI group (4.0% vs. 16.3%; hazard ratio, 0.23; 95% CI, 0.14 to 0.38; P\textless0.001), with no significant between-group differences in the rates of death and myocardial infarction. Urgent revascularizations that were triggered by myocardial infarction or ischemic changes on electrocardiography were less frequent in the PCI group (3.4% vs. 7.0%, P=0.01). In a landmark analysis, the rate of death or myocardial infarction from 8 days to 2 years was lower in the PCI group than in the medical-therapy group (4.6% vs. 8.0%, P=0.04). Among registry patients, the rate of the primary end point was 9.0% at 2 years. CONCLUSIONS: In patients with stable coronary artery disease, FFR-guided PCI, as compared with medical therapy alone, improved the outcome. Patients without ischemia had a favorable outcome with medical therapy alone. (Funded by St. Jude Medical; FAME 2 ClinicalTrials.gov number, NCT01132495.).
Databáze: OpenAIRE
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