May 27th, 2010
Should We Aim For FAME?
L. David Hillis, MD
In patients with multivessel CAD suitable for PCI, what’s the best way to determine whether a stent should be placed? Researchers in the Fractional Flow Reserve Versus Angiography for Multivessel Evaluation (FAME) study compared outcomes when PCI with drug-eluting stents was guided by angiography alone versus angiography plus measurement of FFR. At 2 years of follow-up, routine measurement of FFR significantly reduced mortality and myocardial infarction (by 35%) when compared with angiography-guided PCI.
Still, I am skeptical that the FAME results are applicable to the “real world.” Although FFR measurements were attainable quickly in >90% of subjects, I believe that some — maybe even many — interventionalists are uncomfortable and/or inexperienced in doing them, thereby making the results difficult to trust.
Are you convinced that the addition of FFR to angiography prevents unnecessary stenting (and improves outcomes)? If so, why is it so seldom used?
NEJM Journal Watch — Recent Cardiology Articles- Intensive vs. Standard Blood Pressure Lowering in Patients with Diabetes
- Anticoagulation in Patients with Cancer-Associated Pulmonary Embolism: How Long is Long Enough?
- Spironolactone Use After Percutaneous Intervention for Acute Myocardial Infarction
- CRISPR/Cas9 Gene Editing for Transthyretin Cardiomyopathy
- Does Colchicine Reduce Cardiac Events After Myocardial Infarction?