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Fractional flow reserve-guided percutaneous coronary intervention vs. medical therapy for patients with stable coronary lesions : meta-analysis of individual patient data

Zimmermann, Frederik M. ; Omerovic, Elmir ; Fournier, Stephane ; Kelbæk, Henning ; Johnson, Nils P. ; Rothenbühler, Martina ; Xaplanteris, Panagiotis ; Abdel-Wahab, Mohamed ; Barbato, Emanuele and Høfsten, Dan Eik , et al. (2019) In European Heart Journal 40(2). p.180-186
Abstract

Aims: To assess the effect of fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI) with contemporary drug-eluting stents on the composite of cardiac death or myocardial infarction (MI) vs. medical therapy in patients with stable coronary lesions. Methods and results: We performed a systematic review and meta-analysis of individual patient data (IPD) of the three available randomized trials of contemporary FFR-guided PCI vs. medical therapy for patients with stable coronary lesions: FAME 2 (NCT01132495), DANAMI-3-PRIMULTI (NCT01960933), and Compare-Acute (NCT01399736). FAME 2 enrolled patients with stable coronary artery disease (CAD), while the other two focused on non-culprit lesions in stabilized patients... (More)

Aims: To assess the effect of fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI) with contemporary drug-eluting stents on the composite of cardiac death or myocardial infarction (MI) vs. medical therapy in patients with stable coronary lesions. Methods and results: We performed a systematic review and meta-analysis of individual patient data (IPD) of the three available randomized trials of contemporary FFR-guided PCI vs. medical therapy for patients with stable coronary lesions: FAME 2 (NCT01132495), DANAMI-3-PRIMULTI (NCT01960933), and Compare-Acute (NCT01399736). FAME 2 enrolled patients with stable coronary artery disease (CAD), while the other two focused on non-culprit lesions in stabilized patients after acute coronary syndrome. A total of 2400 subjects were recruited from 54 sites world-wide with 1056 randomly assigned to FFR-guided PCI and 1344 to medical therapy. The pre-specified primary outcome was a composite of cardiac death or MI. We included data from extended follow-ups for FAME 2 (up to 5.5 years follow-up) and DANAMI-3-PRIMULTI (up to 4.7 years follow-up). After a median follow-up of 35 months (interquartile range 12-60 months), a reduction in the composite of cardiac death or MI was observed with FFR-guided PCI as compared with medical therapy (hazard ratio 0.72, 95% confidence interval 0.54-0.96; P = 0.02). The difference between groups was driven by MI. Conclusion: In this IPD meta-analysis of the three available randomized controlled trials to date, FFR-guided PCI resulted in a reduction of the composite of cardiac death or MI compared with medical therapy, which was driven by a decreased risk of MI.

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type
Contribution to journal
publication status
published
subject
in
European Heart Journal
volume
40
issue
2
pages
7 pages
publisher
Oxford University Press
external identifiers
  • scopus:85059503157
  • pmid:30596995
ISSN
1522-9645
DOI
10.1093/eurheartj/ehy812
language
English
LU publication?
yes
id
84e1a44a-fcc6-4f0e-a05d-6d30325f23e1
date added to LUP
2019-01-18 12:12:02
date last changed
2020-10-25 06:33:19
@article{84e1a44a-fcc6-4f0e-a05d-6d30325f23e1,
  abstract     = {<p>Aims: To assess the effect of fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI) with contemporary drug-eluting stents on the composite of cardiac death or myocardial infarction (MI) vs. medical therapy in patients with stable coronary lesions. Methods and results: We performed a systematic review and meta-analysis of individual patient data (IPD) of the three available randomized trials of contemporary FFR-guided PCI vs. medical therapy for patients with stable coronary lesions: FAME 2 (NCT01132495), DANAMI-3-PRIMULTI (NCT01960933), and Compare-Acute (NCT01399736). FAME 2 enrolled patients with stable coronary artery disease (CAD), while the other two focused on non-culprit lesions in stabilized patients after acute coronary syndrome. A total of 2400 subjects were recruited from 54 sites world-wide with 1056 randomly assigned to FFR-guided PCI and 1344 to medical therapy. The pre-specified primary outcome was a composite of cardiac death or MI. We included data from extended follow-ups for FAME 2 (up to 5.5 years follow-up) and DANAMI-3-PRIMULTI (up to 4.7 years follow-up). After a median follow-up of 35 months (interquartile range 12-60 months), a reduction in the composite of cardiac death or MI was observed with FFR-guided PCI as compared with medical therapy (hazard ratio 0.72, 95% confidence interval 0.54-0.96; P = 0.02). The difference between groups was driven by MI. Conclusion: In this IPD meta-analysis of the three available randomized controlled trials to date, FFR-guided PCI resulted in a reduction of the composite of cardiac death or MI compared with medical therapy, which was driven by a decreased risk of MI.</p>},
  author       = {Zimmermann, Frederik M. and Omerovic, Elmir and Fournier, Stephane and Kelbæk, Henning and Johnson, Nils P. and Rothenbühler, Martina and Xaplanteris, Panagiotis and Abdel-Wahab, Mohamed and Barbato, Emanuele and Høfsten, Dan Eik and Tonino, Pim A.L. and Boxma-de Klerk, Bianca M. and Fearon, William F. and Køber, Lars and Smits, Pieter C. and De Bruyne, Bernard and Pijls, Nico H.J. and Jüni, Peter and Engstrøm, Thomas},
  issn         = {1522-9645},
  language     = {eng},
  number       = {2},
  pages        = {180--186},
  publisher    = {Oxford University Press},
  series       = {European Heart Journal},
  title        = {Fractional flow reserve-guided percutaneous coronary intervention vs. medical therapy for patients with stable coronary lesions : meta-analysis of individual patient data},
  url          = {http://dx.doi.org/10.1093/eurheartj/ehy812},
  doi          = {10.1093/eurheartj/ehy812},
  volume       = {40},
  year         = {2019},
}