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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/cdn\/css\/http\/css_Xg7z6oCTVgud_Q0huYz9x9iiD5H_2YPSJ5z2ZViSWdY.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EThis article presents updated trial data that demonstrated that fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI) reduces cardiovascular events when compared to medical therapy in patients with stable coronary artery disease (CAD). The Fractional Flow Reserve-Guided Percutaneous Coronary Intervention Plus Optimal Medical Treatment (OMT) Versus OMT trial [FAME 2; De Bruyne B et al. \u003Cem\u003EN Engl J Med\u003C\/em\u003E. 2014] was undertaken to determine if FFR-guided PCI improves outcomes in patients with stable CAD.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EInterventional Techniques \u0026amp; Devices\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ECoronary Artery Disease\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ECardiology Clinical Trials\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ECardiology\u003C\/li\u003E\u003C\/ul\u003E\u003Cul class=\u0022kwd-group clinical-trial\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EInterventional Techniques \u0026amp; Devices\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ECoronary Artery Disease\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ECardiology Clinical Trials\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EBernard De Bruyne, MD, PhD, Onze-Lieve-Vrouw Ziekenhuis, Aalst, Belgium, presented updated trial data that demonstrated that fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI) reduces cardiovascular events when compared to medical therapy (MT) in patients with stable coronary artery disease (CAD).\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EThe Fractional Flow Reserve-Guided Percutaneous Coronary Intervention Plus Optimal Medical Treatment (OMT) Versus OMT trial [FAME 2; De Bruyne B et al. \u003Cem\u003EN Engl J Med\u003C\/em\u003E. 2014] was undertaken to determine if FFR-guided PCI improves outcomes in patients with stable CAD.\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EFor this trial, 1220 patients with angiographically defined CAD in one or more vessels who were planned for PCI were enrolled. Patients with a history of coronary artery bypass grafting, left ejection fraction \u0026lt; 30%, or left main CAD were excluded. Patients having at least one stenosis with FFR \u2264 0.80 (n = 888) were randomized 1:1 to PCI with (n = 447) or without (n = 441) MT. The remaining 332 patients (FFR \u0026gt; 0.80) were treated with MT and followed in a registry. Follow-up assessments were done after 1 and 6 months, and annually for 5 years. The primary end point was a 2-year composite of all-cause death, myocardial infarction (MI), or urgent revascularization. The trial was stopped after enrolling just over half of the planned patient population due to overwhelming reduction in the primary composite in patients treated with PCI. The initial results of the trial have been previously presented [De Bruyne B et al. \u003Cem\u003EN Engl J Med.\u003C\/em\u003E 2012]. Dr De Bruyne presented updated findings that reflect the 2 years of follow-up as originally planned.\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003EPatients in the randomized and registry groups had similar baseline demographics including prevalence of risk factors for CAD, noncardiac comorbidities, cardiac history, and prevalence of angina (\u003Ca id=\u0022xref-table-wrap-1-1\u0022 class=\u0022xref-table\u0022 href=\u0022#T1\u0022\u003ETable 1\u003C\/a\u003E).\u003C\/p\u003E\u003Cdiv id=\u0022T1\u0022 class=\u0022table pos-float\u0022\u003E\u003Cdiv class=\u0022table-inline\u0022\u003E\u003Cdiv class=\u0022callout\u0022\u003E\u003Cspan\u003EView this table:\u003C\/span\u003E\u003Cul class=\u0022callout-links\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022\/\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/14990\/expansion?postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0026amp;table-expand-inline=1\u0022 html=\u00221\u0022 fragment=\u0022#\u0022 external=\u00221\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022\/highwire\/markup\/14990\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/14990\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv class=\u0022table-caption\u0022\u003E\u003Cspan class=\u0022table-label\u0022\u003ETable 1.\u003C\/span\u003E \n            \u003Cp id=\u0022p-6\u0022 class=\u0022first-child\u0022\u003EFAME 2 Fractional Flow Reserve Measurements\u003C\/p\u003E\n         \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-11\u0022\u003EAt year 2, patients with FFR \u2264 0.80 who were randomized to MT had higher rates of death, MI, or urgent revascularization when compared with patients treated with PCI (HR 0.39; 95% CI, 0.26 to 0.57; \u003Cem\u003EP\u003C\/em\u003E \u0026lt; .001) and patients with FFR \u0026gt; 0.80 who were followed in the registry (HR 2.34; 95% CI, 1.35 to 4.05; \u003Cem\u003EP\u003C\/em\u003E = .002). These outcomes were predominately driven by large reductions in urgent revascularization (HR 0.23; 95% CI, 0.14 to 0.38; \u003Cem\u003EP\u003C\/em\u003E \u0026lt; .001)\u003C\/p\u003E\u003Cp id=\u0022p-12\u0022\u003EPatients with FFR \u2264 0.80 who were randomized to PCI+MT displayed similar outcomes as patients with FFR \u0026gt; 0.80 who were followed in the registry (HR 0.90; 95% CI, 0.49 to 1.64; \u003Cem\u003EP\u003C\/em\u003E = .72) over the 2-year follow-up.\u003C\/p\u003E\u003Cp id=\u0022p-13\u0022\u003EA landmark analysis was also performed at day 7. Patients randomized to PCI had higher rates of death or MI at week 1 (HR 9.01; 95% CI, 1.13 to 72.0). However, in those patients who had no events in week 1, treatment with PCI reduced death or MI by 44% (HR, 0.56; 95% CI, 0.32 to 0.97).\u003C\/p\u003E\u003Cp id=\u0022p-14\u0022\u003EThe reduction in urgent revascularization within week 1 after randomization to PCI + MT did not achieve statistical significance when compared to MT (HR 0.49; 95% CI, 0.09 to 2.70). However, from day 8 to year 2, treatment with PCI+MT reduced urgent revascularization (HR 0.21; 95% CI, 0.12 to 0.37). After year 2, more than 40% of the MT patients required revascularization.\u003C\/p\u003E\u003Cp id=\u0022p-15\u0022\u003EAlthough symptoms decreased in all patients beginning at day 30, the proportion of patients improved was greater in the patients treated with PCI + MT.\u003C\/p\u003E\u003Cp id=\u0022p-16\u0022\u003EIn conclusion, in patients with stable CAD, treatment with FFR \u2264 0.80 and PCI experienced resulted in \u0026gt; 50% fewer deaths, MIs, or urgent revascularizations than treatment with MT. These findings provide strong support for the value of FFR-guided PCI in patients with stable angina.\u003C\/p\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2014 MD Conference Express\u00ae\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/14\/27\/30.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzoule\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_tables.js?nzoule\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}