The Aftermath of a Negative Third FAME
Third FAME Trial
The current guideline recommendations regarding myocardial revascularization of patients with multivessel coronary artery disease (CAD) mostly advocate coronary artery bypass grafting (CABG) over percutaneous coronary intervention (PCI), especially for patients with diabetes. However, in certain clinical cases, PCI can be considered. FAME and FAME 2 studies had demonstrated the superiority of functional flow reserve (FFR)-guided PCI over angiography-guided PCI and over optimal medical therapy (OMT) alone respectively. FAME 3 study (Fractional Flow Reserve versus Angiography for Multivessel Evaluation), published early in 2022, was a study that investigated how PCI guided by FFR measurements can perform compared to CABG guided mostly by coronary angiography for the revascularization of patients with three-vessel CAD. Stable patients with an average SYNTAX score of 26 were randomized, while patients with left main disease, recent ST segment elevation myocardial infarction (STEMI), left ventricular ejection fraction <30% or cardiogenic shock were excluded. Regarding the composite primary endpoint of major adverse cardiovascular events (MACE), including death, non-fatal myocardial infarction, stroke or repeat revascularization, at 1 year follow-up, FFR-guided PCI failed to be proven as non-inferior compared to CABG. The findings of FAME 3 as added to those of FAME and FAME 2 should be considered in the context of current guidelines for myocardial revascularization and do not seem practice changing. Relevant limitations, possible implications and future perspectives are also briefly discussed herein. Rhythmos 2022;17(2): 32-35.
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